Infections of the Aorta: Case Report and Review of Treatment
Infections of the Aorta: Case Report and Review of Treatment
Radiographic documentation of the rapid development of an aortic infection has not previously been reported. We report the case of a 68-year-old woman who presented with back pain. A computed tomographic (CT) scan documented a nondisplaced L1 compression fracture as well as an atherosclerotic but nonaneurysmal aorta. Two weeks after discharge, she developed left lower lobe pneumonia and was readmitted. A second CT scan was obtained because of continuous complaints of back pain. A contained rupture of the visceral aorta was now clearly visible. Emergent operation successfully repaired her aorta.
The microorganisms responsible for aortic infection have changed since the widespread use of antibiotics. Patterns of aortic involvement have also evolved. The difficulty in making these diagnoses, the role of current antibiotic therapy, and the surgical options for these infections will be discussed.
Infections of the abdominal aorta are rare. Before the advent of antibiotics, most cases of aortitis presented as destruction of the aortic wall with subsequent aneurysmal degeneration or pseudoaneurysm formation with frank perforation. The etiology of these infections was most often endocarditis, as demonstrated in the 1923 series reported by Stengel in which 86% of cases of infected aneurysms occurred in patients with endocarditis. Although the advent of antibiotic therapy has decreased the incidence of both endocarditis and aortitis, gram-positive bacteria, such as Staphylococcus and Streptococcus, remain the predominant organisms identified with these infections. This case report presents a successful in situ surgical repair and treatment of a ruptured abdominal aorta pseudoaneurysm infected with methicillin-resistant Staphylococcus aureus (MRSA).
Radiographic documentation of the rapid development of an aortic infection has not previously been reported. We report the case of a 68-year-old woman who presented with back pain. A computed tomographic (CT) scan documented a nondisplaced L1 compression fracture as well as an atherosclerotic but nonaneurysmal aorta. Two weeks after discharge, she developed left lower lobe pneumonia and was readmitted. A second CT scan was obtained because of continuous complaints of back pain. A contained rupture of the visceral aorta was now clearly visible. Emergent operation successfully repaired her aorta.
The microorganisms responsible for aortic infection have changed since the widespread use of antibiotics. Patterns of aortic involvement have also evolved. The difficulty in making these diagnoses, the role of current antibiotic therapy, and the surgical options for these infections will be discussed.
Infections of the abdominal aorta are rare. Before the advent of antibiotics, most cases of aortitis presented as destruction of the aortic wall with subsequent aneurysmal degeneration or pseudoaneurysm formation with frank perforation. The etiology of these infections was most often endocarditis, as demonstrated in the 1923 series reported by Stengel in which 86% of cases of infected aneurysms occurred in patients with endocarditis. Although the advent of antibiotic therapy has decreased the incidence of both endocarditis and aortitis, gram-positive bacteria, such as Staphylococcus and Streptococcus, remain the predominant organisms identified with these infections. This case report presents a successful in situ surgical repair and treatment of a ruptured abdominal aorta pseudoaneurysm infected with methicillin-resistant Staphylococcus aureus (MRSA).