Mycotic aneurysm

Background

A mycotic aneurysm of the pulmonary artery complicating tricuspid infectious endocarditis. The aneurysm has ruptured producing massive hemorrhage.

• Arterial vessel wall dilation due to bacterial, fungal, or viral infection
• Incidence is rare
  • 1-5% of aortic aneurysms and intracranial aneurysms
  • Seen in up to 2% of infective endocarditis cases

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)

Evaluation

Mycotic aneurysm of the left iliac artery seen on angiography.

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))
• MR angiography (Sensitivity 0.79 (95% CI, 0.61–0.91), specificity 0.89 (95% CI, 0.81–0.95))

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

• Abdominal aortic aneurysm