Bashour George, Kinjo Houssam, Kaada Hussein, Issa Rana
Faculty of Medicine, Tishreen University, Latakia, Syria.
Department of Vascular Surgery, Tishreen University Hospital, Latakia, Syria.
Int J Surg Case Rep. 2024 Aug;121:110034. doi: 10.1016/j.ijscr.2024.110034. Epub 2024 Jul 13.
An Infectious Aortic Aneurysm (IAA), also known as a Mycotic Aortic Aneurysm (MAA), is a rare lesion of the aorta resulting from an infection of its wall.
A male patient in his 70s presented to our emergency department with fever, intense abdominal pain, and a pulsatile mass in the middle of the abdomen. A Computed Tomography (CT) angiography scan was done two weeks earlier and it showed a 6.6 cm subrenal aortic aneurysm. A new CT angiography scan revealed a 3.4 cm growth (10109.3) with periaortic fluids. The diagnosis of MAA was considered, and emergency surgery was performed.
MAA is a rare disease characterized by a high risk of rupture and a high mortality rate, up to 43 %, despite the advances in treatment techniques. Adjacent infection is a rare cause for MAA especially on a preexisting aneurysm. The two main surgical approaches are Open Surgical Repair (OSR) and Endo-Vascular Repair (EVR). We opted for OSR with careful debridement because EVR was not available at our center and the huge size of the aneurysm posed high rupture risk.
This case demonstrates the importance of close monitoring and early intervention for aneurysms, particularly in cases with adjacent infection. Moreover, the rapid growth rate and rupture risk demands more urgent intervention if the MAA is suspected.
感染性主动脉瘤(IAA),也称为霉菌性主动脉瘤(MAA),是一种因主动脉壁感染导致的罕见主动脉病变。
一名70多岁的男性患者因发热、剧烈腹痛和腹部中部搏动性肿块被送至我院急诊科。两周前进行了计算机断层扫描(CT)血管造影,显示肾下主动脉瘤直径为6.6厘米。新的CT血管造影显示动脉瘤增大了3.4厘米(10×10×9.3),并伴有主动脉周围积液。考虑诊断为MAA,并进行了急诊手术。
MAA是一种罕见疾病,其特点是破裂风险高、死亡率高,尽管治疗技术有所进步,但死亡率仍高达43%。邻近感染是MAA的罕见病因,尤其是在已有动脉瘤的基础上。两种主要的手术方法是开放手术修复(OSR)和血管腔内修复(EVR)。我们选择了OSR并进行仔细清创,因为我们中心没有EVR,而且动脉瘤尺寸巨大,破裂风险高。
该病例表明对动脉瘤进行密切监测和早期干预的重要性,特别是在存在邻近感染的情况下。此外,如果怀疑为MAA,其快速生长速度和破裂风险需要更紧急的干预。