A 36-year-old man was admitted to the hospital with signs and symptoms of sepsis. He had a history of intravenous drug abuse as well as hepatitis B and C. He was discovered to have a left forearm abscess at an intravenous drug access site, as well as septic arthritis of the left hip with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia.
He underwent incision and drainage of the left hip and conservative management of the left forearm. A computed tomographic arteriogram (CTA) of the abdomen for abdominal pain showed inflammation around the distal abdominal aorta consistent with aortitis (Figure 35-1). Although his clinical course improved, his abdominal pain persisted and a repeat CTA 1 week later showed a large false aneurysm of the distal aorta (Figure 35-2).
Options were discussed and he underwent successful endovascular repair of the aorta (Figures 35-3 and 35-4) and was discharged eventually on long-term antibiotics.
Computed tomographic (CT) scan with periaortic inflammation consistent with aortitis (blue arrow).
Distal aortic mycotic false aneurysm 1 week later (blue arrow).
Aortogram demonstrating distal aortic false aneurysm (blue arrow) and involvement of the iliac vessels.
Successful aortic endograft placement, resolving the false aneurysm.
Infectious aortitis represents a rare etiology of aortic aneurysm with one of the largest reviews revealing that 2.8% of 673 consecutive abdominal aortic aneurysm (AAA) patients presented with infectious aortitis as the etiology, including locations in the thoracic and abdominal aortas.1
The disease is significantly more devastating than traditional aneurysmal disease with a large proportion of patients with a mycotic aneurysm (19%-48%) presenting for the first time with rupture.1,2, and 3
ETIOLOGY OR PATHOPHYSIOLOGY
The term mycotic is actually a misnomer for infectious aortitis since most aortic infections are not secondary to a fungal pathogen. Many organisms have been implicated with S aureus being the most common.
Others include Streptococcus pneumoniae, Listeria monocytogenes, Pseudomonas aeruginosa, Morganella morganii, Pasteurella multocida, and Salmonella species.4,5,6,7,8, and 9
Infections in native vessels are most commonly the result of seeding from a remote source or infections in an immunocompromised host. Infections also occur in previously placed prosthetic grafts, but this is a different disease entity and not the subject of this chapter.