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Infected Thoracic Aneurysm with Progressive Exudative Unilateral Pleural Effusion: A Case Report and Literature
Shin Osawa1, Yasuhiro Kano1, Rentaro Oda2
1Department of Emergency and General Medicine, Tokyo Metropolitan Tama Medical Center, Japan.
Internal Medicine (Tokyo, Japan)
|December 10, 2025
Summary
Diagnosing infected aneurysms is difficult due to vague symptoms. This case highlights how unilateral pleural effusion with high adenosine deaminase (ADA) can mimic other conditions, necessitating blood cultures and imaging for accurate infected aneurysm diagnosis.
Area of Science:
- Medicine
- Cardiology
- Infectious Diseases
Background:
- Infected aneurysms are life-threatening but challenging to diagnose early.
- Non-specific symptoms often delay diagnosis of infected aneurysms.
- Unilateral pleural effusion can be a rare presenting sign of an infected aneurysm.
Purpose of the Study:
- To report a case of infected aneurysm presenting as unilateral pleural effusion.
- To discuss the diagnostic challenges posed by elevated adenosine deaminase (ADA) levels in such cases.
- To emphasize the importance of further investigations for definitive diagnosis.
Main Methods:
- Case report of a 90-year-old female patient.
- Analysis of pleural fluid for cell count and adenosine deaminase (ADA) levels.
- Review of diagnostic procedures including blood cultures and imaging.
Main Results:
- The patient presented with progressive, unilateral pleural effusion.
- Pleural fluid analysis showed a mononuclear cell-predominant exudate with elevated ADA (61.4 U/L).
- The elevated ADA level complicated the diagnosis, potentially suggesting an unrelated condition.
Conclusions:
- Infected aneurysm should be considered in cases of unilateral pleural effusion, even with confounding factors like elevated ADA.
- Elevated ADA levels in pleural fluid can mimic other conditions, leading to potential misdiagnosis.
- Blood cultures and follow-up imaging are crucial for the definitive diagnosis of infected aneurysms.
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