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Infected aortic aneurysms: CT diagnosis
1Department of Surgery, Georgetown University Medical Center, Washington, DC.
Abstract:
Infected aortic aneurysms are uncommon but important because they can lead to uncontrolled sepsis and/or aortic rupture. Symptoms are frequently minimal during the early stages and a high index of suspicion is essential to make the diagnosis. The surgical literature suggests that survival is markedly improved by a prompt diagnosis and aggressive surgical intervention. Our recent experience with 5 cases who underwent arteriography and/or computed tomography (CT) prior to surgery was reviewed and these diagnostic methods compared. Traditionally, arteriography has been considered indispensable in the evaluation of infected aortic aneurysms but the aneurysm lumen must reach a certain size before it can be detected and, even then, the extraluminal component may be underestimated. CT, with contrast enhancement, was more sensitive in the early stages of the disease and provided a more complete depiction of the anatomic abnormalities. Mural enhancement preceded the increase in the aortic lumen with disruption of aortic wall calcification. An earlier and more accurate diagnosis can be provided by CT than by angiography without the disadvantages of its invasiveness and cost.
Insights
Infected aortic aneurysms require early diagnosis for improved survival. Computed tomography (CT) offers a more sensitive and accurate detection method for these uncommon but dangerous conditions compared to traditional arteriography.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
- Infectious Diseases
Background:
- Infected aortic aneurysms are rare but life-threatening, potentially causing sepsis or rupture.
- Early diagnosis and prompt surgical intervention are crucial for patient survival.
- Subtle early symptoms necessitate a high index of suspicion.
Purpose of the Study:
- To compare the diagnostic efficacy of arteriography and computed tomography (CT) for infected aortic aneurysms.
- To evaluate the role of advanced imaging in the early detection of infected aortic aneurysms.
Main Methods:
- Retrospective review of 5 cases with infected aortic aneurysms who underwent arteriography and/or CT.
- Comparison of imaging findings between arteriography and contrast-enhanced CT.
Main Results:
- CT demonstrated higher sensitivity in early disease stages compared to arteriography.
- CT provided a more comprehensive anatomical depiction, identifying mural enhancement preceding lumen dilation.
- Arteriography's limitations include requiring a certain aneurysm size for detection and underestimating extraluminal components.
Conclusions:
- Contrast-enhanced CT is superior to arteriography for early and accurate diagnosis of infected aortic aneurysms.
- CT offers advantages over angiography, including reduced invasiveness and lower cost.
- Enhanced diagnostic accuracy with CT can lead to more timely surgical intervention and improved outcomes.