Hoarseness due to aortic arch aneurysms

Abstract Objective: To give an overview of the Ortner's syndrome caused by an aortic arch aneurysm. Methods: By comprehensive retrieval of the pertinent literature published in the past two decades, 75 reports including 86 patients were collected and recruited into this study along with a recent case of our own. Results: The aortic arch aneurysms causing hoarseness were most commonly mycotic aneurysms. In this patient setting, in addition to the left recurrent laryngeal nerve, trachea was the most commonly affected structure by the aortic arch aneurysm. Surgical/interventional/hybrid treatments led to a hoarseness-relieving rate of 64.3%, much higher than that of patients receiving conservative treatment. However, hoarseness recovery took longer time in the surgically treated patients than in the interventionally treated patients. Conclusion: The surgical and interventional treatments offered similar hoarseness-relieving effects. Surgical or interventional treatment is warranted in such patients for both treatment of arch aneurysms and relief of hoarseness.

A Case of Behçet's Disease Mimicking Vertebral Invasion of a Mycotic Aneurysm / 대한내과학회지

Behçet's disease is a systemic vasculitis of unknown etiology characterized by recurrent oral and genital ulcers and uveitis. The vascular involvement of Behçet's disease affects arteries, veins, and blood vessels of all sizes, and it can include venous or arterial thrombosis and arterial aneurysms. There are only a few reports of an aortic aneurysm invading a vertebral body in a patient with Behçet's disease. Here, we report the case of a 45-year-old man who was initially diagnosed with vertebral invasion of a mycotic aneurysm. He underwent vascular surgery and received empirical antibiotics, but all cultures were negative. However, he had persistent, recurrent deep vein thrombosis and elevated inflammatory markers. After reviewing the pathology, a final diagnosis of Behçet's disease was made. He was successfully treated with corticosteroids. This report presents a rare case of Behçet's disease mimicking vertebral invasion of a mycotic aneurysm.

Mycotic aneurysm with aortoduodenal fistula

Firstly described in the 19th century by Sir William Osler, the mycotic aneurysm (MA) is a rare entity characterized by an abnormal arterial dilation, which is potentially fatal, and is associated with the infection of the vascular wall. Elderly patients are mostly involved, especially when risk factors like chronic diseases, immunosuppression, neoplasia, and arterial manipulation are associated. The authors report the case of a young male patient diagnosed with an aortic aneurysm of infectious origin in the presence of repeated negative blood cultures. The diagnostic hypothesis was raised when the patient was hospitalized for an inguinal hernia surgery. The diagnosis was confirmed based on imaging findings consistent with mycotic aneurism. The patient was treated with an endovascular prosthesis associated with a long-lasting antibiotic therapy. Five months later, the patient attended the emergency unit presenting an upper digestive hemorrhage and shock, from which he died. The autopsy revealed a huge aneurysm of the abdominal aorta with an aortoduodenal fistula. The histological examination of the arterial wall revealed a marked inflammatory process, extensive destruction of the arterial wall, and the presence of Gram-positive bacteria. This case highlights the atypical presentation of a MA associated with an aortoduodenal fistula. Besides the early age of the patient, no primary arterial disease could be found,and no source of infection was detected.

Infectious Pseudoaneurysm Caused by Group A Streptococcus in a Child without Underlying Disease

Group A streptococcus is a common cause of upper respiratory infection in children; however, it is a rare cause of pseudoaneurysm in pediatrics with only limited reports of cases associated with cardiac surgery and underlying disease. We report a case of infectious pseudoaneurysm of the right internal iliac artery caused by group A streptococcus in a previously healthy 5-year-old boy who presented with scarlet fever and group A streptococcal bacteremia. He was admitted to the hospital with fever, rash on the whole body, and sore throat, accompanied by severe leg pain. He was treated with surgical removal and antibiotics. Because a pseudoaneurysm may develop in children without vascularrelated underlying diseases, we should consider the possibility of this important clinical diagnosis in patients with scarlet fever.

Infectious Pseudoaneurysm Caused by Group A Streptococcus in a Child without Underlying Disease

Group A streptococcus is a common cause of upper respiratory infection in children; however, it is a rare cause of pseudoaneurysm in pediatrics with only limited reports of cases associated with cardiac surgery and underlying disease. We report a case of infectious pseudoaneurysm of the right internal iliac artery caused by group A streptococcus in a previously healthy 5-year-old boy who presented with scarlet fever and group A streptococcal bacteremia. He was admitted to the hospital with fever, rash on the whole body, and sore throat, accompanied by severe leg pain. He was treated with surgical removal and antibiotics. Because a pseudoaneurysm may develop in children without vascularrelated underlying diseases, we should consider the possibility of this important clinical diagnosis in patients with scarlet fever.

Clinical analysis of infective endocarditis complicated with intracranial hemorrhage / 中华全科医师杂志

Objective To analyze the clinical characteristics of infective endoearditis complicated with intracranial hemorrhage.Methods The clinical characteristics,brain CT and MRI results and prognosis of 7 patients with infective endocarditis and intracranial hemorrhage admitted between January 1991 and May 2015 were retrospectively analyzed.Results All seven patients presented varying degrees of fever,cardiac murmur and neurological symptoms.The continuous fever lasted from 21 d to 227 d (average 91 d).Mitral valve (4 cases) and aortic valve (3 cases) were the most common affected ones.The brain CT or MRI scan presented intracranial hemorrhage in 6 cases.More than 2 hemorrhage locations were found in 5 patients and parietal lobe was most common one (4 cases).All patients were treated with antimicrobial agents and three patients underwent valve replacement surgery.Three patients were cured and another 2 died due to fatal hemorrhage.Conclusions Patients with long fever history and ineffective antimicrobial treatment are prone to intracranial hemorrhage.Brain CT or MRI scan need be performed in infective endocardits when neurological symptoms are present,and brain angiography should be also considered if necessary.

A Case of an Infected Aneurysm in the Thoracic Aorta Mimicking Tuberculous Lymphadenopathy / 대한내과학회지

Tuberculous-infected aortic aneurysms are rare, but delayed diagnosis can lead to serious complications, including sudden aortic rupture. Here, we report a case of a tuberculous infected aneurysm in the thoracic aorta that was mistaken for lymphadenopathy. In this case, we could differentiate the lesion with the aid of contrast-enhanced computed tomography and positron emission tomography (PET). This case demonstrates the diagnostic value of PET in aortic aneurysms.

Mycotic Abdominal Pseudoaneurysm due to Psoas Abscess after Spinal Fusion

A 36-year-old man, who had undergone thoracoscopic anterior spinal fusion using the plate system and posterior screw fusion three months previously, presented to our hospital with left flank pain and fever. Computed tomography indicated the presence of a psoas muscle abscess. However, after two days of percutaneous catheter drainage, a mycotic abdominal aortic pseudoaneurysm was detected via computed tomography. We performed in situ revascularization using a prosthetic graft with omental wrapping. Methicillin-resistant Staphylococcus aureus was identified on blood and pus culture, and systemic vancomycin was administered for one month. Although the abscess recurred, it was successfully treated with percutaneous catheter drainage and systemic vancomycin administration for three months, without the need for instrumentation removal. The patient remained asymptomatic throughout two years of follow-up.

Infected Aneurysm of the Abdominal Aorta due to Streptococcus pneumoniae / 대한내과학회지

Streptococcus pneumoniae (S. pneumoniae), a bacterium that is part of the normal flora of the upper respiratory tract, can cause pneumonia, bacteremia, otitis media, and meningitis. There are few reports of infected abdominal aortic aneurysms due to S. pneumoniae, especially in Korea. We here present a 53-year-old male with an infected abdominal aortic aneurysm caused by S. pneumoniae. This patient had no previous history of atherosclerosis or infection of other organs such as the lungs, heart, or bones. He underwent resection of the abdominal aorta and iliac artery as well as bypass surgery, with maintenance of peri-operative intravenous antibiotics for 6 weeks. He has shown favorable outcomes after a 3-month follow-up.

Infected Aortic Aneurysm caused by Mycobacterium bovis after Intravesical Bacillus Calmette-Guerin Treatment for Bladder Cancer / 감염과화학요법

A 70-year-old man presented with lower back pain and cyanotic changes in his left lower extremity. He was diagnosed with infected aortic aneurysm and infectious spondylitis. He had received intravesical Bacillus Calmette-Guerin (BCG) therapy up to 1 month before the onset of symptoms. The aneurysm was excised and an aorto-biiliac interposition graft was performed. Mycobacterium tuberculosis complex was cultured in the surgical specimens. Real-time polymerase chain reaction (PCR) targeting the senX3-regX3 region, and multiplex PCR using dual-priming oligonucleotide primers targeting the RD1 gene, revealed that the organism isolated was Mycobacterium bovis BCG. The patient took anti-tuberculosis medication for 1 year, and there was no evidence of recurrence at 18 months follow-up.