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Septic rupture of an atherosclerotic plaque of the ascending aorta

Jean Michel Maillet1, Tonino Palombi, Jean-Louis Sablayrolles

  • 1Department of Cardiovascular and Thoracic Surgery, Centre Cardiologique du Nord, Saint-Denis, France. jm.maillet@ccncardio.com

Interactive Cardiovascular and Thoracic Surgery
|June 26, 2012
PubMed

Insights

Infectious aortitis, though rare, can occur even after antibiotic treatment for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, leading to aortic rupture. Prompt diagnosis and prolonged antibiotics are crucial for recovery.

Area of Science:

  • Cardiovascular Medicine
  • Infectious Diseases
  • Radiology

Background:

  • Infectious aortitis is a rare but serious condition, often associated with bacterial infections.
  • The widespread use of antibiotics has significantly reduced the incidence of infectious aortitis.

Observation:

  • A patient developed acute chest pain and hemodynamic instability 15 days after starting antibiotics for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia.
  • A chest computed tomography (CT) scan revealed a pericardial tamponade caused by the rupture of the ascending aorta at an atherosclerotic plaque site.
  • Intraoperative findings suggested a septic etiology for the aortic rupture.

Findings:

  • Cultures from aortic atherosclerotic plaque samples confirmed the presence of MRSA.
  • The patient recovered well after 12 weeks of antibiotic therapy.
  • Follow-up imaging (transesophageal echocardiography and chest CT) at 3 months showed normal results after antibiotic cessation.

Implications:

  • This case highlights the potential for infectious aortitis to develop despite antibiotic treatment for bacteremia.
  • It underscores the importance of considering septic aortitis in patients with unexplained hemodynamic instability and aortic pathology.
  • The findings emphasize the necessity of prolonged antibiotic therapy and close monitoring for successful management of infectious aortitis.

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