Mycotic aneurysm: Difference between revisions
(Created page with "==Background== *Arterial vessel wall dilation due to bacterial, fungal, or viral infection <ref>Majeed H, Ahmad F. Mycotic Aneurysm. [Updated 2023 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560736/</ref> *Incidence is rare ** 1-5% of aortic aneurysms <ref>Parkhurst GF, Dekcer JP. Bacterial aortitis and mycotic aneurysm of the aorta: a report of twelve cases. Am J Pathol...") |
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** Seen in up to 2% of infective endocarditis cases <ref>González I, Sarriá C, López J, et al. Symptomatic peripheral mycotic aneurysms due to infective endocarditis: a contemporary profile. Medicine (Baltimore) 2014; 93:42–52</ref> | ** Seen in up to 2% of infective endocarditis cases <ref>González I, Sarriá C, López J, et al. Symptomatic peripheral mycotic aneurysms due to infective endocarditis: a contemporary profile. Medicine (Baltimore) 2014; 93:42–52</ref> | ||
===Risk Factors=== | ===Risk Factors=== | ||
* Immunocompromised | * Immunocompromised | ||
| Line 12: | Line 11: | ||
* status post invasive intravascular procedures | * status post invasive intravascular procedures | ||
==Clinical Features== | |||
===Signs/Symptoms=== | ===Signs/Symptoms=== | ||
*Fever | *Fever | ||
| Line 17: | Line 17: | ||
*Localized inflammation at arterial access site (if s/p intravascular intervention) | *Localized inflammation at arterial access site (if s/p intravascular intervention) | ||
*Symptoms may vary by location affected (e.g. stroke-like symptoms with intracranial aneurysm, abdominal pain with mycotic AAA) | *Symptoms may vary by location affected (e.g. stroke-like symptoms with intracranial aneurysm, abdominal pain with mycotic AAA) | ||
==Differential Diagnosis== | |||
==Evaluation== | ==Evaluation== | ||
| Line 42: | Line 44: | ||
==See Also== | ==See Also== | ||
[[Abdominal Aortic Aneurysm]] | *[[Abdominal Aortic Aneurysm]] | ||
==External Links== | |||
==References== | ==References== | ||
<references/> | <references/> | ||
Revision as of 19:36, 1 May 2024
Background
- Arterial vessel wall dilation due to bacterial, fungal, or viral infection [1]
- Incidence is rare
Risk Factors
- Immunocompromised
- IV drug use
- Infective endocarditis
- status post invasive intravascular procedures
Clinical Features
Signs/Symptoms
- Fever
- Pulsatile mass
- Localized inflammation at arterial access site (if s/p intravascular intervention)
- Symptoms may vary by location affected (e.g. stroke-like symptoms with intracranial aneurysm, abdominal pain with mycotic AAA)
Differential Diagnosis
Evaluation
Labs
- CBC
- ESR/CRP
- CMP
- Urinalysis
- Blood cultures
- Coagulation studies
- Type and Cross
Imaging
- CT angiography (Sensitivity 0.82 (95% CI, 0.77–0.87), specificity 0.93 (95% CI, 0.89–0.95)) [7]
- MR angiography (Sensitivity 0.79 (95% CI, 0.61–0.91), specificity 0.89 (95% CI, 0.81–0.95)) [8]
Management
- Emergent vascular surgery consultation
- Broad spectrum IV antibiotics with gram positive, gram negative, and anaerobic coverage
- Bilateral large-bore peripheral IVs
- Definitive care with surgical debridement and endovascular vs open repair
Disposition
- Admission to OR or ICU in consultation with vascular surgery
See Also
External Links
References
- ↑ Majeed H, Ahmad F. Mycotic Aneurysm. [Updated 2023 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560736/
- ↑ Parkhurst GF, Dekcer JP. Bacterial aortitis and mycotic aneurysm of the aorta: a report of twelve cases. Am J Pathol 1955; 31:821–835
- ↑ Sommerville RL, Allen EV, Edwards JE. Bland and infected arteriosclerotic abdominal aortic aneurysms: a clinicopathologic study. Medicine (Baltimore) 1959; 38:207–221
- ↑ Kannoth S, Thomas SV. Intracranial microbial aneurysm (infectious aneurysm): current options for diagnosis and management. Neurocrit Care 2009; 11:120–129
- ↑ Nakahara I, Taha MM, Higashi T, et al. Different modalities of treatment of intracranial mycotic aneurysms: report of 4 cases. Surg Neurol 2006; 66:405–409; discussion, 409–410
- ↑ González I, Sarriá C, López J, et al. Symptomatic peripheral mycotic aneurysms due to infective endocarditis: a contemporary profile. Medicine (Baltimore) 2014; 93:42–52
- ↑ Wang TKM, Griffin B, Cremer P, et al. Diagnostic Utility of CT and MRI for Mycotic Aneurysms: A Meta-Analysis. AJR Am J Roentgenol. 2020;215(5):1257-1266. doi:10.2214/AJR.19.22722
- ↑ Wang TKM, Griffin B, Cremer P, et al. Diagnostic Utility of CT and MRI for Mycotic Aneurysms: A Meta-Analysis. AJR Am J Roentgenol. 2020;215(5):1257-1266. doi:10.2214/AJR.19.22722