Mycotic Pseudoaneurysm of the Aortic Arch

A 59 year-old male presents with fever and left parasternal pain. Past medical history included arterial hypertension, dyslipidemia, smoking, obesity. His clinical exam was unremarkable. Both C-reactive protein and leucocytes were elevated. Chest computed tomography (CT) demonstrated a 18mm saccular pseudoaneurysm of the aortic arch with extensive adjacent densification and adenopathy (Figure 1 and 2). Methicillin-sensible Staphylococcus aureus was isolated from blood cultures. A transesophageal echocardiogram excluded endocarditis. Control Angio-CT after seven days showed a contained rupture and increase in diameter of the pseudoaneurysm. He underwent emergent surgery with circulatory arrest and anterograde cerebral perfusion; extensive resection of the pseudoaneurysmal aorta was performed, with reconstruction of the aortic arch using autologous pericardium, without implantation of foreign or synthetic material (Figure 3 and 4). He completed 4 weeks of Flucloxacillin IV, having been discharged under oral antibiotics.