Jutidamrongphan Warissara, Kritpracha Boonprasit, Sörelius Karl, Hongsakul Keerati, Suwannanon Ruedeekorn
Department of Radiology, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Rd., Hat Yai, Songkhla, 90110, Thailand.
Department of Surgery, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Rd, Hat Yai, Songkhla, 90110, Thailand.
Insights Imaging. 2022 Jan 8;13(1):2. doi: 10.1186/s13244-021-01135-x.
Infective native aortic aneurysm (INAA) is a rare clinical diagnosis. The purpose of this study was to describe the CT findings of INAAs in detail.
This was a retrospective single-center study of INAA patients at a major referral hospital between 2005 and 2020. All images were reviewed according to a protocol consisting of aneurysm features, periaortic findings, and associated surrounding structures.
One hundred and fourteen patients (mean age, 66 years [standard deviation, 11 years]; 91 men) with 132 aneurysms were included. The most common locations were infrarenal (50.8%), aortoiliac (15.2%), and juxtarenal (12.9%). The mean transaxial diameter was 6.2 cm. Most INAAs were saccular (87.9%) and multilobulated (91.7%). Calcified aortic plaque was present in 93.2% and within the aneurysm in 51.5%. INAA instability was classified as contained rupture (27.3%), impending rupture (26.5%), and free rupture (3.8%). Rapid expansion was demonstrated in 13 of 14 (92.9%) aneurysms with sequential CT studies. Periaortic inflammation was demonstrated as periaortic enhancement (94.7%), fat stranding (93.9%), soft-tissue mass (92.4%), and lymphadenopathy (62.1%). Surrounding involvement included psoas muscle (17.8%), spondylitis (11.4%), and perinephric region (2.8%). Twelve patients demonstrated thoracic and abdominal INAA complications: fistulas to the esophagus (20%), bronchus (16%), bowel (1.9%), and inferior vena cava (IVC) (0.9%).
The most common CT features of INAA were saccular aneurysm, multilobulation, and calcified plaques. The most frequent periaortic findings were enhancement, fat stranding, and soft-tissue mass. Surrounding involvement, including psoas muscle, IVC, gastrointestinal tract, and bronchi, was infrequent but may develop as critical INAA complications.
感染性原发性主动脉瘤（INAA）是一种罕见的临床诊断。本研究的目的是详细描述INAA的CT表现。
这是一项对2005年至2020年间在一家大型转诊医院的INAA患者进行的回顾性单中心研究。所有图像均按照由动脉瘤特征、主动脉周围表现及相关周围结构组成的方案进行回顾。
纳入114例患者（平均年龄66岁[标准差11岁]；91例男性），共132个动脉瘤。最常见的部位是肾下（50.8%）、主-髂动脉（15.2%）和肾旁（12.9%）。平均横轴直径为6.2cm。大多数INAA为囊状（87.9%）且多叶状（91.7%）。93.2%存在钙化主动脉斑块，51.5%位于动脉瘤内。INAA的不稳定性分为局限性破裂（27.3%）、即将破裂（26.5%）和游离破裂（3.8%）。在14个动脉瘤中的13个（92.9%）通过连续CT研究显示有快速扩张。主动脉周围炎症表现为主动脉周围强化（94.7%）、脂肪条索影（93.9%）、软组织肿块（92.4%）和淋巴结肿大（62.1%）。周围受累包括腰大肌（17.8%）、脊柱炎（11.4%）和肾周区域（2.8%）。12例患者出现胸腹部INAA并发症：与食管形成瘘管（20%）、支气管（16%）、肠道（1.9%）和下腔静脉（IVC）（0.9%）。
INAA最常见的CT特征是囊状动脉瘤、多叶状和钙化斑块。最常见的主动脉周围表现是强化、脂肪条索影和软组织肿块。包括腰大肌、IVC、胃肠道和支气管在内的周围受累情况不常见，但可能发展为严重的INAA并发症。
