Ho Vy Thuy, Itoga Nathan K, Wu Tiffany, Sorial Ehab, Garcia-Toca Manuel
Department of Surgery, Division of Vascular Surgery, Stanford University, Stanford, CA, USA.
Case Rep Surg. 2018 May 7;2018:7080813. doi: 10.1155/2018/7080813. eCollection 2018.
Mycotic renal artery aneurysms are rare and can be difficult to diagnose. Classic symptoms such as hematuria, hypertension, or abdominal pain can be vague or nonexistent. We report a case of a 53-year-old woman with a history of intravenous drug abuse presenting with critical limb ischemia, in which CT angiography identified a mycotic renal aneurysm. This aneurysm tripled in size from 0.46 cm to 1.65 cm in a 3-week interval. Echocardiography demonstrated aortic valve vegetations leading to a diagnosis of culture-negative endocarditis. The patient underwent primary resection and repair of the aneurysm, aortic valve replacement, and left below-knee amputation after bilateral common iliac and left superficial femoral artery stenting. At 1-year follow-up, her serum creatinine is stable and repaired artery remains patent.
真菌性肾动脉瘤罕见且难以诊断。血尿、高血压或腹痛等典型症状可能不明确或不存在。我们报告一例53岁有静脉药物滥用史的女性，出现严重肢体缺血，CT血管造影发现真菌性肾动脉瘤。该动脉瘤在3周内从0.46厘米增大到1.65厘米，大小增至原来的三倍。超声心动图显示主动脉瓣赘生物，导致诊断为血培养阴性的心内膜炎。患者在双侧髂总动脉和左股浅动脉支架置入术后，接受了动脉瘤一期切除和修复、主动脉瓣置换及左膝下截肢手术。随访1年时，她的血清肌酐稳定，修复后的动脉保持通畅。
