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Ruptured emphysematous infectious aortitis after endoprothesis placement

Y. Yen, F.-Z. Wu
DOI: http://dx.doi.org/10.1093/qjmed/hcu086 943-944 First published online: 12 April 2014

An 80-year-old man presented to the emergency department with persistent fever, retrosternal pain and cold sweating for 1 week. He had undergone endovascular aortic stent repair of a thoracic aortic aneurysm 3 months ago. On examination, his body temperature was 38.6°C, heart rate was 99 bpm and blood pressure was 98/60 mm Hg. Laboratory studies revealed leukocytosis with elevated C-reactive protein of 19.6 mg/dl. A radiograph of the chest showed that endovascular stent repair of the thoracic aortic aneurysm, and increasing soft tissue opacities over the aortic arch and left upper lung field. CT angiography of the thorax showed ruptured aneurysmal sac with contrast extravasation (Figure 1), peri-aortic hematoma accumulation (Figure 1b) and scanty air bubbles formation in the aneurysmal sac (Figure 1b). Blood culture yielded Escherichia coli. Sudden episode of massive bloody vomitus with circulatory arrest occurred within several hours later, and the patient died without response to cardiopulmonary resuscitation.

Figure 1.

CT of the thoracic aorta with 3-D volume rendering (a) showed endovascular stent graft repair for aortic arch aneurysm and contrast material leakage (black arrow) at the proximal end of the stent. Sagittal view of the computed tomography (b) revealed ruptured aneurysmal sac with peri-aortic hematoma accumulation (white arrowhead), fluid collection with peripheral enhancement of the aneurysmal wall, contrast material leakage (black arrow) at the proximal end of stent and scanty air bubbles formation (white arrow).

Normally, the aorta is quite resistant to infection unless some predisposing factors make it vulnerable to infection, such as association with atherosclerotic disease, pre-existing aneurysm, cystic medial necrosis, diabetes, vascular malformation, medical devices or surgery.1 Endograft infection is a rare and life-threatening complication after endovascular repair with an increased incidence because of the increased frequency of invasive procedure, which may cause high risk of morbidity and mortality.2,3 Thoracic aortic endograft infection has the highest incidence of aorto-bronchial fistula formation, which may present with massive hemoptysis, indicates a very poor prognosis despite intensive treatment.1

Funding

Supported by Grants from Kaohsiung Veterans General Hospital, VGHKS103-015, Taiwan, R.O.C.

Conflict of interest: None declared.

References