11/22. rupture of a nonaneurysmal aorta secondary to Staphylococcus aortitis.Infectious aortitis has become increasingly uncommon and, when diagnosed, typically occurs in an immunocompromised elderly male with a history of Staphylococcus or Salmonella infection and underlying atheromatous cardiovascular disease. The authors report a case of a 74-year-old man with aortitis complicated by rupture secondary to staphylococcus aureus infection. The patient presented with worsening abdominal pain and fever after being discharged from the emergency room 2 weeks before with back pain and leukocytosis diagnosed as urinary tract infection and bronchitis. Computed tomography (CT) imaging of the retroperitoneum on the first visit appeared normal. Repeat CT scan on the subsequent visit revealed a contained rupture of a nonaneurysmal aorta at the level of the diaphragm. The patient was taken to the operating room emergently for repair. An infected periaortic hematoma and a 1 cm perforation in the posterior aorta were found. The aorta was excised and the area debrided. Revascularization was performed using a 22 mm extruded polytetrafluoroethylene (ePTFE) interposition graft placed in situ. This case demonstrates that a high index of suspicion is required in diagnosing infectious aortitis and that the diagnosis may be delayed in many cases. Additionally, it may not be uncommon for the infected aorta to rupture without prior aneurysm formation.- - - - - - - - - - ranking = 1keywords = back pain, abdominal pain, back (Clic here for more details about this article) |
12/22. Salmonella aortitis at Ramathibodi Hospital, Bangkok, thailand.Two cases of Salmonella aortitis were diagnosed by positive culture from the wall of aortic aneurysm. Common features in both cases included fever, abdominal/back pain and pulsatile abdominal mass with underlying severe atherosclerosis. The fatal outcome of both cases despite surgical and medical treatment was discussed and guideline of management was proposed.- - - - - - - - - - ranking = 0.039781181294023keywords = back (Clic here for more details about this article) |
13/22. Tuberculous aortitis with associated necrosis and perforation: treatment and options.Tuberculous aortitis is a rare entity and its association with necrosis and perforation is even more unusual. Our pulmonary medicine service originally evaluated an elderly woman with a right pleural effusion and upper lobe infiltrate thought to be tuberculosis. An abdominal CT scan performed at that time showed extensive periaortic adenopathy. isoniazid and rifampin were started, but both were stopped by the patient after less than 6 months of therapy. The patient later had night sweats, a left pleural effusion, and a tender abdominal mass thought to be a symptomatic aneurysm. At operation, the aorta was necrotic and had an inflammatory mass and perforation on the left side. Infrarenal aortic ligation and resection were performed to control infection. A previously placed axillofemoral graft obviated the need for concomitant revascularization. The patient was treated postoperatively with isoniazid and rifampin until hyperbilirubinemia developed, which necessitated alternate therapy with ethambutol and streptomycin. The patient died one month after operation of a presumed pulmonary embolus.- - - - - - - - - - ranking = 0.00065963353068854keywords = upper (Clic here for more details about this article) |
14/22. Effort angina without coronary obstruction in a patient with Takayasu's aortitis: a case report.Angina occurring in patients with Takayasu's aortitis is attributed to the narrowing of the coronary ostium and/or aortic regurgitation. We treated a patient with Takayasu's aortitis with effort angina, in whom there was no obstruction of the ostium or aortic regurgitation. Treadmill exercise stress test revealed significant ST depression in leads V4-6, II, III and aVF with chest pain. Examinations of lactate in coronary sinus as well as arterial blood suggested the occurrence of myocardial ischemia during atrial pacing. The DPTI/TTI index was decreased and the left ventricular end-diastolic pressure was increased during angina. It is considered that the reduced coronary perfusion pressure resulted from a low diastolic aortic pressure and the elevated left ventricular end-diastolic pressure decreased the DPTI/TTI index and contributed to the development of subendocardial ischemia.- - - - - - - - - - ranking = 0.0080076152212604keywords = chest (Clic here for more details about this article) |
15/22. A case of aortitis syndrome with severe coarctation of the aorta.A 17 year old female with aortitis syndrome was reported. The blood pressure of upper extremities was 204/88 mmHg which was higher than that of lower extremities (88/mmHg). Chest X ray showed marked rib notchings at the lower border of the right 7th and 8th rib and left 8th ribs. Stenosis of the thoracic aorta was observed at the upper border of the 9th rib and the lower border of the 10th rib with marked development of collateral circulation. After 6 months treatment with steroids, inflammation signs were improved and thickness of the aorta was decreased which was detected by computed tomography. However, blood pressure was not decreased by the combined antihypertensive treatment.- - - - - - - - - - ranking = 0.0013192670613771keywords = upper (Clic here for more details about this article) |
16/22. Recurrent salmonella septicaemia with aortitis, osteomyelitis and psoas abscess.A patient with low back pain and recurrent salmonella typhimurium septicaemia is described. Investigations revealed an aortic aneurysm, lumbar osteomyelitis and a psoas abscess. The importance of thorough investigation of patients with low back pain and salmonella septicaemia is emphasised.- - - - - - - - - - ranking = 1.5631883190116keywords = back pain, back (Clic here for more details about this article) |
17/22. Pneumococcal aortitis in the antibiotic era.The pneumococcus remains in the antibiotic era a formidable pathogen, capable of atypical, lethal clinical presentations. We report two fatal cases of thoracic aortitis caused by streptococcus pneumoniae in the setting of bacteremic illness from this pathogen. One case occurred in an aortic graft and the other arose in a native aorta. We also discuss the indolent clinical presentation and the diagnostic failure of transesophageal echocardiography and leukocyte scintigraphy. Persistent pyrexia with atypical chest pain and unexplained blood loss should alert clinicians to the possibility of this uncommon, yet lethal complication of pneumococcal disease.- - - - - - - - - - ranking = 0.0080076152212604keywords = chest (Clic here for more details about this article) |
18/22. aortitis with dissection complicating systemic lupus erythematosus.A 31 yr old female under treatment for systemic lupus erythematosus complained of episodes of atypical chest pain radiating to the back. Subsequently she suddenly collapsed and died. Post mortem revealed a well-defined, localized area of non-giant cell aortitis extending from the supra-aortic ridge of the aortic valve to the ligamentum arteriosum. Active arteritis with fibrinoid necrosis and obliterative endarteritis of vasa vasorum had resulted in multiple infarcts of differing ages with associated inflammation and disruption of the aortic wall, culminating in aortic dissection and cardiac tamponade.- - - - - - - - - - ranking = 0.047788796515283keywords = back, chest (Clic here for more details about this article) |
19/22. Lymphoplasmacytic aortitis and acute aortic dissection. An uncommon association.A 43-year-old white man with a history of cigarette smoking, hypertension, nephrolithiasis, and cervical degenerative arthritis was hospitalized for sudden-onset severe, substernal, and pleuritic chest pain with epigastric radiation. Despite evaluation, the cause remained unclear and the patient expired on hospital day 5. autopsy revealed acute Stanford type A aortic dissection, hemopericardium, and hemothorax. Grossly, the aorta and its branches, including uninvolved medium-sized arteries, displayed extreme mural fragility. Microscopic examination showed a primary lymphoplasmacytic aortitis-periaortitis without giant cells. Rents within the tunica media, medial-adventitial inflammation, and elastic fiber disruption were limited to sites of gross aortic dissection. Muscular arteries showed patchy, chronic arteritis-periarteritis without giant cell infiltrate or aneurysm formation. This case documents an unusual association of primary lymphoplasmacytic aortitis and aortic dissection.- - - - - - - - - - ranking = 0.0080076152212604keywords = chest (Clic here for more details about this article) |
20/22. Primary clostridium septicum aortitis: a rare cause of necrotizing suprarenal aortic infection. A case report and review of the literature.A 74-year old woman sought medical attention for general symptoms of nausea, vomiting, and back pain. A computed tomographic scan showed gas in the wall of the descending thoracic and suprarenal aortas. Emergency thoracoabdominal exploration revealed a necrotizing infection of the thoracic aorta extending to the origin of the celiac axis. After surgery clostridium septicum was identified in tissue culture. Surgical management consisted of in-situ graft replacement of the thoracoabdominal aorta. Three months later, a pseudoaneurysm developed at the distal anastomosis. The patient refused further surgery and died 3 days later. The cause of death was presumed to be a ruptured mycotic aneurysm as a result of recurrent C. septicum infection. The relationship of C. septicum with occult gastrointestinal and hematologic malignancy has been documented. This patient represents the 10th reported case of C. septicum arteritis. Including the nine previous case reports of C. septicum arteritis, the mortality rate is 70%. When evaluating a patient with a mycotic aneurysm or aortitis, C. septicum should be considered. If it is found, a search should be carried out for an associated gastrointestinal or hematologic malignancy. Surgical repair should include extraanatomic revascularization and wide debridement of the infected field. Consideration should be given to lifelong antimicrobial therapy for this potentially fatal infection.- - - - - - - - - - ranking = 0.78159415950579keywords = back pain, back (Clic here for more details about this article) |
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