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Mycotic carotid aneurysm
Abstract:
Mycotic aneurysms of the extracranial internal carotid artery are rare; they usually appear as an enlarging pulsatile neck mass with associated pain, tenderness, and fever. This case report illustrates the need for prompt diagnosis and urgent surgical intervention. The most common organisms found with these aneurysms have been Staphylococcus aureus and Streptococcus pyogenes. We report a case of a mycotic internal carotid artery aneurysm resulting from Salmonella enteritidis. A 20-year review of both the foreign and English language literature revealed only one other case of a mycotic carotid aneurysm resulting from Salmonella infection. The cornerstone of therapy in the past had been proximal ligation. More recently, primary reconstructive procedures with either an end-to-end anastomosis or an interposition vein graft have been described. The present case was managed with an end-to-end technique with the use of a Pruitt-Inahara shunt.
Insights
Mycotic aneurysms of the extracranial internal carotid artery are rare. Prompt diagnosis and surgical intervention are crucial, with Salmonella enteritidis being a rare cause.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Microbiology
Background:
- Mycotic aneurysms of the extracranial internal carotid artery (ICA) are uncommon vascular infections.
- Typically present as pulsatile neck masses with pain, tenderness, and fever.
- Staphylococcus aureus and Streptococcus pyogenes are the most frequently implicated organisms.
Observation:
- This case report details a rare instance of a mycotic ICA aneurysm caused by Salmonella enteritidis.
- A literature review identified only one prior case of Salmonella-related mycotic carotid aneurysm.
- The patient presented with symptoms consistent with an infected aneurysm.
Findings:
- The diagnosis required prompt recognition and urgent surgical management.
- The patient's infection was caused by Salmonella enteritidis, an unusual pathogen for this condition.
- Successful surgical repair was achieved using an end-to-end anastomosis with a Pruitt-Inahara shunt.
Implications:
- Highlights the importance of considering unusual pathogens like Salmonella in mycotic aneurysms.
- Emphasizes the necessity of timely surgical intervention for extracranial ICA mycotic aneurysms.
- Demonstrates the efficacy of reconstructive surgical techniques, such as end-to-end anastomosis, in managing these rare conditions.