Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Ruptured infected aortic aneurysm (pseudoaneurysm)
- Radiologic Findings
- Fig 1. Chest PA shows a mass surrounded by the air density and outer thick rim in the left upper mediastinum. The trachea is deviated to the right.
Fig 2-4. Chest CT scan reveals a mass in contact with the aortic arch, with surrounding mesh-like layered air density and outer thick soft tissue density rim in the left superior mediastinum. Disrupted intimal calcifications are noted.
Fig 5. Chest X-ray after 9 days showed a rapid increase in the size of the mass compared with the previous X-ray.
- Brief Review
- An infected aneurysm is rarely seen in the thoracic aorta. Aortic infection develops when a pathogen offends a vulnerable vessel wall. The focus of infection can develop in a normal caliber vessel or an existing aneurysm. Patients present with fever, chest pain, hemoptysis, and respiratory symptoms, which may be misdiagnosed as pneumonia, especially in patients with no history of aneurysm. Treatment consists of antibiotics and urgent surgery. The overall mortality rate is 16%–40% but has been reported to be as high as 67%. Saccular aneurysm, rapid expansion or development, and soft-tissue mass, stranding, and/or fluid in an unusual location are imaging findings that are highly suspicious for infected aortic aneurysm. Periaortic gas and adjacent vertebral body changes are helpful features, although they occur infrequently. It is important to rule out aortic pathology if a patient presents with rapidly expanding infiltrates close to the mediastinum. Prompt diagnosis can improve mortality and morbidity by early surgical intervention.
- References
- 1. Thanila A. Macedo, Anthony W. Stanson, Gustavo S. Oderich, C. Michael Johnson, Jean M. Panneton, and Mark L. Tie, Infected Aortic Aneurysms: Imaging Findings, Radiology 2004 231:1, 250-257
2. P. Ramadas, P. Krishnan, V.T. Chandrasekar, C.A. Gilman, N. Gnanabakthan, J. Lamichhane, Infected aortic aneurysmal rupture masquerading as pneumonia, QJM: An International Journal of Medicine, Volume 109, Issue 5, May 2016, Pages 343–344, https://doi.org/10.1093/qjmed/hcw031
- Keywords