ABSTRACT
We report a case of a 75-year-old man who had been complaining of fever and pelvic pain for 3 weeks. First angio-computed tomography (CT) characteristics and blood culture led to suspicion of a pneumococcal-infected aortic aneurysm, which however was not confirmed by the surgeon. The abdominal infectious aortitis caused by Streptococcus pneumoniae was affirmed by a second angio-CT performed 7 days later. Without further delay, the patient underwent surgery for resection of mycotic aneurysm and in situ reconstruction with aortobiiliac homograft, in association with antibiotics. He died 10 days after the surgery as a result of severe sepsis in a polyvalent intensive care unit. This case report highlights the severity of this pathology. We reviewed the relevant literature related to Streptococcal pneumoniae mycotic aneurysm located in the abdominal aorta, including 29 more cases. Various microorganisms have already been associated with mycotic aneurysms, including S pneumoniae. Infectious aortitis remains a rare disease. It is extremely important to establish an early diagnosis but it may be delayed because clinical manifestations are usually nonspecific. However, if left untreated it is always lethal. Antibiotic in combination with complete surgical excision of the infected aorta is the treatment of reference. This therapeutic association dramatically improved patient survival.
Subject(s)
Aneurysm, Infected/microbiology , Aortic Aneurysm, Abdominal/microbiology , Aortitis/microbiology , Streptococcal Infections/microbiology , Streptococcus pneumoniae/isolation & purification , Aged , Aneurysm, Infected/diagnostic imaging , Aneurysm, Infected/surgery , Anti-Bacterial Agents/therapeutic use , Aortic Aneurysm, Abdominal/diagnostic imaging , Aortic Aneurysm, Abdominal/surgery , Aortitis/diagnostic imaging , Aortitis/surgery , Aortography/methods , Blood Vessel Prosthesis Implantation , Fatal Outcome , Humans , Male , Streptococcal Infections/diagnostic imaging , Streptococcal Infections/surgery , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Macroscopic study of the first rib has been described by Kunos et al. as an efficient method of age estimation. We retrospectively reviewed a test sample of 160 first right ribs obtained from multislice computed tomography (MSCT) clinical investigations of living individuals aged 15-30 years old. Based on the descriptions of Kunos et al., we analyzed the morphological appearance of the sternal end of the first rib on two- and three-dimensional MSCT reconstructions and defined changes in appearance in stages (from 2 to 5). We also studied the calcification and ossification of the costal cartilage as an independent feature. By statistical analysis (ANOVA), we determined for each gender the correlation between the estimated stage of the costal face, the appearance of the costal cartilage, and the documented age of the subjects. We demonstrated that MSCT of the first rib appears to be an efficient noninvasive modality for bone age estimation.
