Horie Yuki, Ohuchi Shingo, Oyama Shogo
Department of Cardiovascular Surgery, Nakadori General Hospital, Akita, Japan.
Kyobu Geka. 2022 Nov;75(12):1003-1006.
The patient is a 62-year-old man. He was referred to our hospital from a nearby clinic with a complaint of chest and back pain, and was urgently admitted with a diagnosis of Stanford type A (Debakey typeⅢbR) acute aortic dissection. During the course of his treatment, he developed a urinary tract infection caused by methicillin-resistant Staphylococcus aureus (MRSA). Thereafter, the patient developed bacteremia, and follow-up computed tomography( CT) showed a rapidly enlarging descending aortic aneurysm and a left external iliac artery( EIA) aneurysm. On day 49 after admission, thoracic endovascular aortic repair, left EIA resection, and right EIA-left femoral artery bypass were performed. However, a contrast-enhanced CT scan on day 70 of hospitalization revealed a type Ia endoleak and enlargement of the descending aortic aneurysm, so the patient underwent replacement of the descending aorta on day 84. Postoperatively, the patient needed time for recovery, but was discharged on day 158. Three years after discharge, there has been no recurrence of infection, and the patient has been visiting our outpatient clinic. We report a case of acute aortic dissection with rapidly enlarged aneurysm after MRSA bacteremia. This serious condition was succesfully cured with continued antibiotic treatment, two surgical resections and revascularization.
患者为一名62岁男性。他因胸痛和背痛被附近诊所转诊至我院，并因诊断为斯坦福A型（德巴基ⅢbR型）急性主动脉夹层而紧急入院。在治疗过程中，他发生了由耐甲氧西林金黄色葡萄球菌（MRSA）引起的尿路感染。此后，患者出现菌血症，后续计算机断层扫描（CT）显示降主动脉瘤迅速增大以及左髂外动脉（EIA）动脉瘤。入院后第49天，进行了胸段主动脉腔内修复术、左EIA切除术以及右EIA-左股动脉旁路移植术。然而，住院第70天的增强CT扫描显示存在Ⅰa型内漏以及降主动脉瘤增大，因此患者在第84天接受了降主动脉置换术。术后，患者需要时间恢复，但在第158天出院。出院三年后，感染未复发，患者一直在我院门诊就诊。我们报告了一例MRSA菌血症后伴有迅速增大动脉瘤的急性主动脉夹层病例。通过持续的抗生素治疗、两次手术切除和血管重建，这种严重情况成功治愈。
