Leonardou Polytimi, Gioldasi Sofia, Zavos George, Pappas Paris
Department of Radiology, Laikon General Hospital of Athens, 17 Ag, Thoma str,, 115 27Athens, Greece.
J Med Case Rep. 2012 Feb 14;6:59. doi: 10.1186/1752-1947-6-59.
Kidney transplantation can be complicated by infection and subsequent development of mycotic aneurysm, endangering the survival of the graft and the patient. Management of this condition in five cases is discussed, accompanied by a review of the relevant literature.
Five patients, three men 42-, 67- and 57-years-old and two women 55- and 21-years-old (mean age of 48 years), all Caucasians, developed a mycotic aneurysm in the region of the anastomosis between renal graft artery and iliac axes. Four patients presented with systemic fever and iliac fossa pain and one presented with hemorrhagic shock. Morphologic investigation by color doppler ultrasonography revealed a pseudoaneurysm at the anastomotic site. A combination of antibiotic therapy, surgery and interventional procedures was required as all kidney transplants had to be removed. No recurrence was recorded during the follow-up period.
A high index of suspicion is required for the timely diagnosis of a mycotic aneurysm; aggressive treatment with cover stents and/or surgical excision is necessary in order to prevent potentially fatal complications.
肾移植可能并发感染以及随后的霉菌性动脉瘤形成，危及移植肾和患者的存活。本文讨论了5例这种情况的处理，并对相关文献进行了综述。
5例患者，3名男性，年龄分别为42岁、67岁和57岁，2名女性，年龄分别为55岁和21岁（平均年龄48岁），均为白种人，在肾移植动脉与髂血管吻合区域发生霉菌性动脉瘤。4例患者出现全身发热和髂窝疼痛，1例出现失血性休克。彩色多普勒超声形态学检查显示吻合部位有假性动脉瘤。由于所有移植肾均需切除，因此需要联合应用抗生素治疗、手术和介入治疗。随访期间未记录到复发情况。
对于霉菌性动脉瘤的及时诊断需要高度的怀疑指数；为预防潜在的致命并发症，必须采用带覆膜支架和/或手术切除进行积极治疗。
