Aortic Arch Mycotic Aneurysm
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Thomas P. Marnejon
A 74-year-old man was admitted to the hospital after presenting with neck pain, sudden-onset dyspnea, and dysphagia. His vital signs were as follows: heart rate, 101 beats/min; respiration rate, 22/min; blood pressure, 144/83 mm Hg; and temperature, 96.7°F. His white blood cell count was 18,100/μL and erythrocyte sedimentation rate, 82 mm/h. Physical examination revealed wheezing, tachycardia, and bilateral lower extremity edema. Chest computed tomographic scan revealed a 6-cm anterior mediastinal mass. A magnetic resonance image revealed a pseudoaneurysm of the aortic arch beyond the left subclavian artery origin (image A, arrow) with an abscess surrounding the aneurysm (image B, arrow). The patient was given vancomycin intravenously and transitioned to nafcillin, 2 g every 4 hours, after blood culture results were positive for Staphylococcus aureus on hospital day 3. Magnetic resonance image of the cervical spine showed discitis and osteomyelitis from C6 to C7, with epidural abscess and prevertebral space fluid, extending inferiorly to the aorta. The patient died on hospital day 10.
The term mycotic aneurysm was first described by Osler in a case of ulcerative bacterial endocarditis, in which ulcerative endarteritis in the aortic arch produced multiple aneurysms.1 Direct inoculation, contiguous infection, bacterial seeding, or septic emboli can cause mycotic aneurysm.2-6 Management includes antibiotics, debridement, and revascularization.7
References
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© 2018 American Osteopathic Association
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Articles in the same Issue
- EDITORIAL
- Osteopathic Medical Education: Answering the Call
- JAOA/AACOM MEDICAL EDUCATION
- Educational Intervention in a Medically Underserved Area
- Factors Associated With Osteopathic Primary Care Residency Choice Decisions
- Interprofessional Collaborative Practice: Use of Simulated Clinical Experiences in Medical Education
- Assessment Considerations for Core Entrustable Professional Activities for Entering Residency
- Resident and Faculty Attitudes Toward Osteopathic-Focused Education
- Single Accreditation System Update: A Year of Progress
- APPENDIX
- Appendix 1: Osteopathic Graduate Medical Education, 2018
- Appendix 2: American Osteopathic Association Specialty Board Certification
- CLINICAL IMAGES
- Aortic Arch Mycotic Aneurysm
- Bronchopulmonary Sequestration
- IN YOUR WORDS
- Shared Journey in Medicine: Following in My Father's Footsteps
Articles in the same Issue
- EDITORIAL
- Osteopathic Medical Education: Answering the Call
- JAOA/AACOM MEDICAL EDUCATION
- Educational Intervention in a Medically Underserved Area
- Factors Associated With Osteopathic Primary Care Residency Choice Decisions
- Interprofessional Collaborative Practice: Use of Simulated Clinical Experiences in Medical Education
- Assessment Considerations for Core Entrustable Professional Activities for Entering Residency
- Resident and Faculty Attitudes Toward Osteopathic-Focused Education
- Single Accreditation System Update: A Year of Progress
- APPENDIX
- Appendix 1: Osteopathic Graduate Medical Education, 2018
- Appendix 2: American Osteopathic Association Specialty Board Certification
- CLINICAL IMAGES
- Aortic Arch Mycotic Aneurysm
- Bronchopulmonary Sequestration
- IN YOUR WORDS
- Shared Journey in Medicine: Following in My Father's Footsteps
