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Acute type B aortic dissection complicated with a mycotic aortic arch aneurysm
Katsuhiko Matsuyama1, Masahiko Matsumoto, Takaaki Sugita
1Department of Cardiovascular Surgery, Tenri Hospital, Nara, Japan.
The Japanese Journal of Thoracic and Cardiovascular Surgery : Official Publication of the Japanese Association for Thoracic Surgery = Nihon Kyobu Geka Gakkai Zasshi
|November 19, 2003
Summary
A rare case of acute type B aortic dissection with a mycotic aneurysm caused by Bacteroides fragilis was successfully treated. Surgical graft replacement and omental flap coverage led to a full recovery without infection recurrence.
Area of Science:
- Cardiovascular Surgery
- Infectious Diseases
- Vascular Surgery
Background:
- Acute type B aortic dissection is a life-threatening condition.
- Mycotic aneurysms, infections of the aorta, are rare but serious complications.
- Co-occurrence of these conditions presents significant diagnostic and therapeutic challenges.
Observation:
- A 69-year-old male presented with symptoms suggestive of infection, including fever and elevated C-reactive protein (CRP).
- He also exhibited increased hepatobiliary enzyme activity.
- Imaging revealed an acute type B aortic dissection associated with a mycotic aneurysm in the distal aortic arch.
Findings:
- Abscess culture from the distal arch aneurysm identified Bacteroides fragilis as the causative agent.
- The patient underwent successful Dacron graft replacement between the distal arch and proximal descending aorta.
- The graft was reinforced with Teflon felt and covered with an omental flap to promote healing and prevent reinfection.
Implications:
- This case highlights the successful management of a complex aortic pathology involving dissection and infection.
- Surgical intervention with graft replacement and omental coverage proved effective in eradicating the infection and restoring aortic integrity.
- The successful outcome underscores the importance of prompt diagnosis and aggressive treatment for mycotic aortic aneurysms associated with aortic dissection.