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Published on: September 28, 2015
Infected aortic aneurysms: imaging findings
Thanila A Macedo1, Anthony W Stanson, Gustavo S Oderich
1Department of Radiology and Division of Vascular Surgery, Mayo Clinic and Foundation, 200 First St SW, Rochester, MN 55905, USA. macedo.thanila@mayo.edu
Purpose:
To determine the imaging characteristics of infected aortic aneurysms.
Materials And Methods:
Review of records of patients with surgical and/or microbiologic proof of infected aortic aneurysm obtained over a 25-year period revealed 31 aneurysms in 29 patients. This study included 21 men and eight women (mean age, 70 years). One radiologist reviewed 28 computed tomographic (CT) studies (22 patients underwent CT once and three patients underwent CT twice), 12 arteriograms (12 patients underwent arteriography once), eight nuclear medicine studies (six patients underwent nuclear medicine imaging once and one patient underwent nuclear medicine imaging twice), and three magnetic resonance (MR) studies (three patients underwent MR imaging once). Features evaluated included aneurysm size, shape, and location; branch involvement; aortic wall calcification; gas; radiotracer uptake on nuclear medicine studies; and periaortic and associated findings. The location of infected aortic aneurysms was compared with that of arteriosclerotic aneurysms.
Results:
Aneurysms were located in the ascending aorta (n = 2, 6%), descending thoracic aorta (n = 7, 23%), thoracoabdominal aorta (n = 6, 19%), paravisceral aorta (n = 2, 6%), juxtarenal aorta (n = 3, 10%), infrarenal aorta (n = 10, 32%), and renal artery (n = 1, 3%). Two patients had two infected aortic aneurysms. CT revealed 25 saccular (93%) and two fusiform (7%) aneurysms with a mean diameter at initial discovery of 5.4 cm (range, 1-11 cm). Paraaortic soft-tissue mass, stranding, and/or fluid was present in 13 (48%) of 27 aneurysms, and early periaortic edema with rapid aneurysm progression and development was present in three (100%) patients with sequential studies. Other findings included adjacent vertebral body destruction with psoas muscle abscess (n = 1, 4%), kidney infarct (n = 1, 4%), absence of calcification in the aortic wall (n = 2, 7%), and periaortic gas (n = 2, 7%). Angiography showed 13 saccular aneurysms with lobulated contour in 10 (77%). Nuclear medicine imaging showed increased activity consistent with infection in six (86%) of seven aneurysms. MR imaging showed three saccular aneurysms. Adjacent abnormal vertebral body marrow signal intensity was seen in one (33%) of three patients.
Conclusion:
Saccular aneurysms (especially those with lobulated contour) with rapid expansion or development and adjacent mass, stranding, and/or fluid in an unusual location are highly suspicious for an infected aneurysm.
Insights
Infected aortic aneurysms are often saccular with lobulated contours and may present with adjacent masses or fluid. Imaging findings like rapid expansion and unusual locations suggest infection.
Area of Science:
- Radiology
- Vascular Surgery
- Infectious Diseases
Background:
- Infected aortic aneurysms are rare but life-threatening conditions.
- Accurate and timely diagnosis is crucial for effective treatment.
- Imaging plays a key role in identifying characteristic features of infected aortic aneurysms.
Purpose of the Study:
- To delineate the specific imaging characteristics of infected aortic aneurysms.
- To differentiate infected aortic aneurysms from arteriosclerotic aneurysms based on imaging findings.
- To establish imaging criteria suggestive of aortic aneurysm infection.
Main Methods:
- Retrospective review of 31 infected aortic aneurysms in 29 patients over 25 years.
- Analysis of computed tomographic (CT), arteriography, nuclear medicine, and magnetic resonance (MR) imaging studies.
- Evaluation of aneurysm size, shape, location, branch involvement, calcification, gas, radiotracer uptake, and periaortic findings.
Main Results:
- Infected aortic aneurysms were predominantly saccular (93%) and located in the infrarenal aorta (32%).
- Associated findings included paraaortic soft-tissue mass/stranding/fluid (48%), rapid expansion, vertebral body destruction, and periaortic gas.
- Angiography highlighted saccular morphology with lobulated contours; nuclear medicine showed increased activity in infected cases.
Conclusions:
- Saccular aneurysms with lobulated contours, rapid expansion, and adjacent masses/fluid are highly suspicious for infection.
- Unusual locations combined with these imaging features increase suspicion for infected aortic aneurysms.
- These imaging findings aid in the early diagnosis and management of infected aortic aneurysms.
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