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Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
J Cardiovasc Comput Tomogr. 2020 Nov-Dec;14(6):e99-e104. doi: 10.1016/j.jcct.2019.01.018. Epub 2019 Jan 26.
Infected coronary artery aneurysms (ICAA) represent a rare but potentially fatal complication of pre-existent atherosclerotic or non-atherosclerotic coronary artery disease, percutaneous coronary artery intervention, endocarditis or extracardiac infection.
A retrospective analysis of four cases in addition to 51 infected coronary artery aneurysms from the literature, for a total of 55 ICAA was performed. Clinical and morphological information including age, sex, clinical presentation, microbial cultures, size, location and associated abnormalities as well as patient outcome was reviewed.
83% of affected patients were adult males, with an average age of 55.24 years. The right coronary artery was the most commonly affected vessel (40%). In nearly 80% of the time, the responsible organism was either Staphylococcus aureus (53.3%), or Streptococcus (20%) infection. ICAA are typically large, on average 3.4 cm in diameter and can measure up to 9 cm. On contrast enhanced CT, imaging features include lobulated contour or saccular shape (54.2%) with thick wall or mural thrombus (87.5%). Associated abnormal appearance of the pericardium with either pericardial fluid, thickening or loculation is common (79.2%).
ICAA are typically large, and characterized by a thick wall with a lobulated or saccular shape. Association with mediastinal, chest wall or pericardial abnormalities are common. This combination of findings, in the setting of fever, known infection, or recent coronary intervention should raise concern for ICAA.
感染性冠状动脉瘤（ICAA）是先前存在的动脉粥样硬化或非动脉粥样硬化性冠状动脉疾病、经皮冠状动脉介入治疗、心内膜炎或心脏外感染的一种罕见但潜在致命的并发症。
对 4 例病例进行回顾性分析，并结合文献中的 51 例感染性冠状动脉瘤，共分析了 55 例 ICAA。回顾了包括年龄、性别、临床表现、微生物培养、大小、位置和相关异常以及患者预后在内的临床和形态学信息。
83%的受影响患者为成年男性，平均年龄为 55.24 岁。右冠状动脉是最常受累的血管（40%）。近 80%的时间，致病病原体为金黄色葡萄球菌（53.3%）或链球菌（20%）感染。ICAA 通常较大，平均直径为 3.4 厘米，最大可达 9 厘米。在对比增强 CT 上，影像学特征包括分叶状轮廓或囊状形状（54.2%），伴有厚壁或壁血栓（87.5%）。心包与心包积液、增厚或分隔相关的异常表现很常见（79.2%）。
ICAA 通常较大，特征为厚壁呈分叶状或囊状。与纵隔、胸壁或心包异常相关很常见。在发热、已知感染或近期冠状动脉介入治疗的情况下，这些发现的组合应引起对 ICAA 的关注。
