Nagano Naoko, Yamamoto Taira, Amano Atsushi, Kikuchi Ken
Department of Cardiovascular Surgery, Kobari General Hospital, Noda, Chiba, Japan.
Interact Cardiovasc Thorac Surg. 2010 Mar;10(3):459-61. doi: 10.1510/icvts.2009.224980. Epub 2009 Dec 9.
A 76-year-old woman had a chest pain and high fever, and was admitted to the intensive care unit diagnosed as acute pericarditis. Enhanced CT-scan showed a 47-mm aneurysm in the aortic arch which seemed to be impending rupture and the part of the aorta looked like a pseudoaneurysm. Emergent total aortic arch replacement with a rifampicin-bonded Dacron graft was performed. Pericardial effusion was purulent and the aorta was infected with pus discharge in the aortic wall. There were some ulcerations on the surface of the luminal wall of the aorta. One of them was penetrating into the pericardial space causing a pseudoaneurysm. Both pericardial effusion and excised aortic wall were sent to culture study and resulted in positive for Streptococcus pneumoniae. The infection of the aorta, with erosion into the pericardial space, seemed to be the cause of purulent pericarditis. Antibiotic therapy was commenced immediately after surgery and continued for four weeks. Though she had neurological deficit after surgery, her infection was well controlled and there was no recurrence of infection 11 months after surgery.
一名76岁女性出现胸痛和高热，被收入重症监护病房，诊断为急性心包炎。增强CT扫描显示主动脉弓有一个47毫米的动脉瘤，似乎即将破裂，主动脉的一部分看起来像假性动脉瘤。紧急进行了利福平结合涤纶人工血管全主动脉弓置换术。心包积液为脓性，主动脉感染，主动脉壁有脓液排出。主动脉腔壁表面有一些溃疡。其中一个溃疡穿透至心包腔形成假性动脉瘤。心包积液和切除的主动脉壁均送去做培养研究，结果显示肺炎链球菌呈阳性。主动脉感染并侵蚀至心包腔，似乎是脓性心包炎的病因。术后立即开始抗生素治疗，并持续了四周。虽然她术后有神经功能缺损，但感染得到了很好的控制，术后11个月没有感染复发。
