ABSTRACT
Abstract Mycotic pseudoaneurysms of the superficial femoral artery (SFA) are rare and are usually secondary to colonization of an atherosclerotic plaque during an episode of bacteremia. We describe the case of a 68 year-old diabetic male who presented to the Emergency Department with pyrexia and a painful expanding mass in the left thigh. He had a history of diarrhea and had been treated 16 days earlier for an SFA pseudoaneurysm that had been excluded with a covered stent with no adjunctive antibiotic therapy. Angio CT showed an abscess surrounding femoral vessels and stent thrombosis. Under general anesthesia, we performed extensive debridement, removal of the endovascular material, SFA ligation, and empirical antibiotic therapy. Blood and tissue cultures were positive for Escherichia coli. At the 3-months follow up visit, the patient reported he had no claudication. In selected patients, mycotic pseudoaneurysms can be treated by SFA ligation.
Resumo Pseudoaneurismas micóticos da artéria femoral superficial (AFS) são raros, e geralmente são secundários à colonização de uma placa aterosclerótica durante bacteremia. Relatamos o caso de um paciente masculino diabético de 68 anos que chegou ao Serviço de Emergência com pirexia e massa expansiva dolorosa na coxa esquerda. Apresentava histórico de diarreia e havia sido tratado 16 dias antes para pseudoaneurisma da AFS, que foi excluído com stent coberto e sem antibioticoterapia adjuvante. A angiotomografia computadorizada demonstrou um abscesso ao redor dos vasos femorais e trombose do stent. Sob anestesia geral, realizamos desbridamento extenso, remoção do material endovascular, ligadura de AFS e antibioticoterapia empírica. Culturas de sangue e tecidos foram positivas para Escherichia coli. Na consulta de seguimento aos 3 meses, o paciente negou claudicação. Em pacientes selecionados, pseudoaneurismas micóticos podem ser tratados com ligadura de AFS.
Subject(s)
Humans , Male , Aged , Aneurysm, Infected , Aneurysm, False , Femoral Artery , Thigh , Stents , Escherichia coli/pathogenicity , Endovascular Procedures , FeverABSTRACT
Resumen La trombosis venosa profunda (TVP) es una enfermedad frecuente que afecta anualmente al 0,1-0,3% de la población general; además es una causa importante de morbimortalidad en el paciente oncológico. La TVP se produce con más frecuencia en la fase de tratamiento en la que se asocian los efectos protrombóticos del proceso neoplásico y de la quimioterapia. En un menor número de casos se identifica en el diagnóstico o incluso puede ser su primer síntoma. Una TVP focal secundaria a compresión extrínseca y desestructuración de los tejidos circundantes eleva la sospecha de un proceso maligno. Se presenta un caso de TVP focal como primomanifestación de un linfoma no Hodgkin difuso de células grandes B.
Abstract Deep venous thrombosis (DVT) is a common disease that annually affects 0.1-0.3% of the general population; It is also a significant cause of morbidity and mortality in cancer patients. DVT occurs more frequently in the treatment phase in which they are associated with the neoplastic prothrombotic process and effects of chemotherapy. In a small number of cases it is identified in the diagnosis or it may even be its first symptom. A secondary focal DVT extrinsic compression and destruction of surrounding tissue raises the suspicion of a malignant process. A case is presented of a focal DVT that was the first manifestation a non-Hodgkin's diffuse large B-cell lymphoma.