Vascular Auto-Tamponade of an Infected (Mycotic) Aneurysm of the Aortic Arch and Innominate Artery
Background: Infected aortic aneurysms pose significant therapeutic challenges, given the fragility of infected aneurysmal tissue. Mycotic aneurysms caused by <i>Streptococcus agalactiae</i> are rare and may progress in the absence of classical systemic infection signs. Here, we discuss t...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2025-05-01
|
| Series: | Hearts |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2673-3846/6/2/13 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849432648587411456 |
|---|---|
| author | David Derish Rayhaan Bassawon Jeremy Y. Levett Roupen Hatzakorzian Dominique Shum-Tim |
| author_facet | David Derish Rayhaan Bassawon Jeremy Y. Levett Roupen Hatzakorzian Dominique Shum-Tim |
| author_sort | David Derish |
| collection | DOAJ |
| description | Background: Infected aortic aneurysms pose significant therapeutic challenges, given the fragility of infected aneurysmal tissue. Mycotic aneurysms caused by <i>Streptococcus agalactiae</i> are rare and may progress in the absence of classical systemic infection signs. Here, we discuss the surgical management of an unusual presentation of a mycotic aneurysm and its rapid progression with no incremental changes in the patient’s symptoms. Case: A 72-year-old woman presented with subacute general deterioration and back pain. A general workup revealed a mycotic aneurysm of the aortic arch, at the level of the brachiocephalic artery. Initial CT showed a 7 × 5.5 mm pseudoaneurysm that enlarged to 41 × 26 mm within three weeks, despite clinical improvement of her presenting symptoms on antibiotics. Given that the lesion progressed, a staged procedure, consisting of a left carotid–subclavian bypass followed by proximal arch repair, was undertaken with success. Intra-operatively, a completely thrombosed innominate vein was found compressing—and likely tamponading—the pseudoaneurysm, a phenomenon that may have prevented catastrophic rupture. A Dacron graft was sewn end-to-end to the distal ascending aorta; the posterior half of this distal anastomosis incorporated the rim of the innominate artery defect to create a single hemostatic suture line. Conclusions: This case demonstrates a benign initial presentation can degenerate into a catastrophic pseudoaneurysm and how rapidly progressive thoracic infected aneurysms can develop. Heightened clinical acumen is required for accurate diagnosis. Close follow-up is also suggested based on the rapid progression experienced by our patient. Serial imaging, rather than symptomatic or laboratory response alone, should guide the timing of intervention. |
| format | Article |
| id | doaj-art-6f31d64cc1194950926f4fbf81b9452e |
| institution | Kabale University |
| issn | 2673-3846 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Hearts |
| spelling | doaj-art-6f31d64cc1194950926f4fbf81b9452e2025-08-20T03:27:18ZengMDPI AGHearts2673-38462025-05-01621310.3390/hearts6020013Vascular Auto-Tamponade of an Infected (Mycotic) Aneurysm of the Aortic Arch and Innominate ArteryDavid Derish0Rayhaan Bassawon1Jeremy Y. Levett2Roupen Hatzakorzian3Dominique Shum-Tim4Faculty of Medicine and Health Sciences, McGill University, 845 Sherbrooke St. W, Montréal, QC H3A 0G4, CanadaFaculty of Medicine and Health Sciences, McGill University, 845 Sherbrooke St. W, Montréal, QC H3A 0G4, CanadaDivision of Cardiac Surgery and Surgical Research, McGill University Health Center, 1001 Boulevard Décarie, Montréal, QC H4A 3J1, CanadaDepartment of Anaesthesia, Division of Adult Anaesthesia, McGill University Health Center, 1001 Boulevard Décarie, Montréal, QC H4A 3J1, CanadaDivision of Cardiac Surgery and Surgical Research, McGill University Health Center, 1001 Boulevard Décarie, Montréal, QC H4A 3J1, CanadaBackground: Infected aortic aneurysms pose significant therapeutic challenges, given the fragility of infected aneurysmal tissue. Mycotic aneurysms caused by <i>Streptococcus agalactiae</i> are rare and may progress in the absence of classical systemic infection signs. Here, we discuss the surgical management of an unusual presentation of a mycotic aneurysm and its rapid progression with no incremental changes in the patient’s symptoms. Case: A 72-year-old woman presented with subacute general deterioration and back pain. A general workup revealed a mycotic aneurysm of the aortic arch, at the level of the brachiocephalic artery. Initial CT showed a 7 × 5.5 mm pseudoaneurysm that enlarged to 41 × 26 mm within three weeks, despite clinical improvement of her presenting symptoms on antibiotics. Given that the lesion progressed, a staged procedure, consisting of a left carotid–subclavian bypass followed by proximal arch repair, was undertaken with success. Intra-operatively, a completely thrombosed innominate vein was found compressing—and likely tamponading—the pseudoaneurysm, a phenomenon that may have prevented catastrophic rupture. A Dacron graft was sewn end-to-end to the distal ascending aorta; the posterior half of this distal anastomosis incorporated the rim of the innominate artery defect to create a single hemostatic suture line. Conclusions: This case demonstrates a benign initial presentation can degenerate into a catastrophic pseudoaneurysm and how rapidly progressive thoracic infected aneurysms can develop. Heightened clinical acumen is required for accurate diagnosis. Close follow-up is also suggested based on the rapid progression experienced by our patient. Serial imaging, rather than symptomatic or laboratory response alone, should guide the timing of intervention.https://www.mdpi.com/2673-3846/6/2/13mycotic aneurysmaneurysm progressionstaged procedure |
| spellingShingle | David Derish Rayhaan Bassawon Jeremy Y. Levett Roupen Hatzakorzian Dominique Shum-Tim Vascular Auto-Tamponade of an Infected (Mycotic) Aneurysm of the Aortic Arch and Innominate Artery Hearts mycotic aneurysm aneurysm progression staged procedure |
| title | Vascular Auto-Tamponade of an Infected (Mycotic) Aneurysm of the Aortic Arch and Innominate Artery |
| title_full | Vascular Auto-Tamponade of an Infected (Mycotic) Aneurysm of the Aortic Arch and Innominate Artery |
| title_fullStr | Vascular Auto-Tamponade of an Infected (Mycotic) Aneurysm of the Aortic Arch and Innominate Artery |
| title_full_unstemmed | Vascular Auto-Tamponade of an Infected (Mycotic) Aneurysm of the Aortic Arch and Innominate Artery |
| title_short | Vascular Auto-Tamponade of an Infected (Mycotic) Aneurysm of the Aortic Arch and Innominate Artery |
| title_sort | vascular auto tamponade of an infected mycotic aneurysm of the aortic arch and innominate artery |
| topic | mycotic aneurysm aneurysm progression staged procedure |
| url | https://www.mdpi.com/2673-3846/6/2/13 |
| work_keys_str_mv | AT davidderish vascularautotamponadeofaninfectedmycoticaneurysmoftheaorticarchandinnominateartery AT rayhaanbassawon vascularautotamponadeofaninfectedmycoticaneurysmoftheaorticarchandinnominateartery AT jeremyylevett vascularautotamponadeofaninfectedmycoticaneurysmoftheaorticarchandinnominateartery AT roupenhatzakorzian vascularautotamponadeofaninfectedmycoticaneurysmoftheaorticarchandinnominateartery AT dominiqueshumtim vascularautotamponadeofaninfectedmycoticaneurysmoftheaorticarchandinnominateartery |