Tabuchi A, Inada H, Murakami T, Masaki H, Ishida A, Fujiwara T
Department of Surgery, Kawasaki Medical School, Kurashiki, Japan.
Jpn J Thorac Cardiovasc Surg. 1998 Feb;46(2):231-5. doi: 10.1007/BF03250625.
A 66-year-old male was admitted to our hospital because of pyrexia, chest pain and hemosptum. Inflammatory findings were made and salmonella enteritidis was detected by bacterial examination of sputum and stool. Enhanced chest CT examination disclosed a descending thoracic aortic aneurysm which had ruptured into the left lower lobe of the lung. Under a diagnosis of ruptured mycotic descending thoracic aortic aneurysm, an emergency operation was performed. A left posterolateral thoracotomy carried out after axillo-bilateral femoral bypass grafting. A pseudoaneurysm of the descending thoracic aorta had ruptured into the left lower lobe of the lung. After resection of the aneurysm, closure of both ends of the intact descending thoracic aorta and a left lower lobectomy were carried out. An ascending aorta-infrarenal abdominal aorta bypass was performed because of insufficient visceral arterial blood flow through the axillo-bilateral femoral bypass. The patient's immediate postoperative recovery was complicated by paraplegia. Chloramphenicol and levofloxacin were administered for three months, after which his recovery followed a good course.
一名66岁男性因发热、胸痛和咯血入院。检查发现有炎症,通过痰液和粪便细菌检查检测到肠炎沙门氏菌。胸部增强CT检查显示降主动脉瘤破裂至左下肺叶。诊断为霉菌性降主动脉瘤破裂后,进行了急诊手术。在腋-双侧股动脉搭桥术后行左后外侧开胸术。降主动脉假性动脉瘤已破裂至左下肺叶。切除动脉瘤后,缝合完整的降主动脉两端并进行左下肺叶切除术。由于通过腋-双侧股动脉搭桥的内脏动脉血流不足,进行了升主动脉-肾下腹主动脉搭桥术。患者术后立即出现截瘫并发症。给予氯霉素和左氧氟沙星治疗三个月,此后恢复良好。