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Mycotic femoral aneurysm
Richard Scott Wilson1, Kenneth R Bennett
1University of Mississippi School of Medicine, Jackson 39216, USA. rwilson@umsmed.edu
Journal of the Mississippi State Medical Association
|October 19, 2007
Summary
A mycotic aneurysm in the femoral artery, caused by Salmonella, presented as a pulsatile mass. Prompt surgical resection and antibiotic treatment led to an uneventful recovery.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Cardiology
Background:
- Mycotic aneurysms, infections of arterial walls, pose significant risks, often stemming from bacterial endocarditis or septic emboli.
- Salmonella species are a notable cause of mycotic aneurysms, second only to Staphylococcus species.
Observation:
- A 31-year-old presented with fever, chills, and a painful, pulsating thigh mass with a bruit, indicative of a false aneurysm.
- Angiography revealed contrast extravasation from the profunda femoral artery into a large sac.
- Despite initial negative blood cultures, surgical specimens and cavity cultures identified gram-negative bacteria, Salmonella and Alcaligenes.
Findings:
- Surgical resection of the false aneurysm was performed, revealing gram-positive cocci on cut sections.
- Post-operatively, the patient developed aortic valve destruction due to endocarditis, necessitating valve replacement.
- Intravenous ampicillin therapy was initiated and continued, leading to a successful recovery.
Implications:
- This case highlights Salmonella as a significant pathogen in mycotic aneurysm formation, particularly involving the femoral artery.
- Early diagnosis and combined surgical and antimicrobial management are crucial for favorable outcomes in mycotic aneurysms.
- The presentation underscores the importance of considering mycotic aneurysms in patients with fever, pulsatile masses, and risk factors like endocarditis.
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