Subject(s)
Bone and Bones , Esophagoscopy/methods , Esophagus , Foreign Bodies/diagnostic imaging , Chest Pain/diagnosis , Chest Pain/etiology , Emergency Service, Hospital , Follow-Up Studies , Foreign Bodies/surgery , Humans , Male , Middle Aged , Risk Assessment , Seafood/adverse effects , Thorax , Tomography, X-Ray Computed/methods , Treatment OutcomeABSTRACT
PURPOSE: To characterize imaging findings from computed tomography, magnetic resonance imaging, and angiogram in patients with infected aortic aneurysm. METHODS: We retrospectively reviewed the records of 21 patients (men, 17; women, 4) with proven infected aortic aneurysms and compared the imaging findings (computed tomography scans, n = 21; magnetic resonance images, n = 2; and angiograms, n = 2). RESULTS: Aneurysms were located in the descending thoracic aorta (n = 10; 47.6%), abdominal aorta (n = 6; 28.6%), aortic arch (n = 3; 14.3%), and thoracoabdominal aorta (n = 2; 9.5%). Aneurysms were saccular in 19 (90%) and fusiform in 2 (10%). Maximal diameters were greater than 10 cm in 2 patients (10%), 5 to 10 cm in 11 (52%), and less than 5 cm in 8 (38%). Average diameters were 6.5 cm in the aortic arch, 5.3 cm in the descending thoracic aorta, and 5.1 cm in the abdominal aorta. Obvious aortic wall calcification occurred in 19 patients (90%). Other features included disrupted calcification (n = 15; 71%), prominent and irregular wall thickening (n = 17; 81%), periaortic soft tissue mass (n = 15; 71%), rim enhancement (n = 18; 86%), periaortic gas (n = 7; 33%), periaortic stranding and fluid retention (n = 14; 67%), periaortic hematoma (n = 3; 14%), adjacent bone destruction (n = 1; 5%), pleural effusion (n = 12; 57%), and associated dissecting aneurysm (n = 2; 10%). CONCLUSIONS: Saccular aneurysms, adjacent soft tissue masses, rim enhancement, stranding, fluid, gas, and unusual adjacent bony destruction highly suggest infected aneurysm.
Subject(s)
Aneurysm, Infected/diagnosis , Angiography, Digital Subtraction/methods , Aortic Aneurysm/diagnosis , Magnetic Resonance Imaging/methods , Tomography, X-Ray Computed/methods , Adult , Aged , Aged, 80 and over , Aorta/pathology , Aortography/methods , Contrast Media/administration & dosage , Escherichia coli Infections/diagnosis , Female , Humans , Image Enhancement/methods , Imaging, Three-Dimensional , Klebsiella Infections/diagnosis , Male , Middle Aged , Neisseriaceae Infections/diagnosis , Retrospective Studies , Salmonella Infections/diagnosis , Staphylococcal Infections/diagnosis , Streptococcal Infections/diagnosisABSTRACT
OBJECTIVE: Our purpose was to compare clinical outcomes in patients with acute abdominal pain and inner-layer enhancement of a thickened small-bowel wall, as shown on CT, with outcomes in similar patients without such enhancement. MATERIALS AND METHODS: We retrospectively studied outcomes in 126 patients with acute abdominal pain and small-bowel wall thickening on CT: 84 with inner-layer enhancement and 42 without this enhancement. We compared the surgical, small-bowel resection, small-bowel necrosis, and mortality rates between the two groups using the chi-square test. RESULTS: Among the 42 patients without inner-layer enhancement, 32 (76%) underwent an operation, 27 (64%) received segmental small-bowel resection, 26 (62%) had small-bowel necrosis, and seven (17%) died. All of these proportions were significantly higher (p < 0.01) than the corresponding rates-34 (40%), nine (11%), five (6%), and two (2%), respectively-in the 84 patients with inner-layer enhancement. All 31 patients with necrotic small bowel had pathologic evidence of ischemic necrosis involving the mucosa. CONCLUSION: Among patients with acute abdominal pain, those whose CT scans did not show inner-layer enhancement of a thickened small-bowel wall were more prone to undergo surgery and small-bowel resection and were more likely to have small-bowel necrosis than those with such enhancement. Poor inner-layer enhancement on CT might be consistent with sloughed or necrotic mucosa, as observed on pathology.
