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Mycotic (Infected) Pseudoaneurysm, a Diagnostic Challenge – Case Series

Authors
  • Sharma, Praveen K1
  • Garisa, Sai Sindhura1
  • Kumaran, S. Vinod1
  • Varma, Sparsh1
  • 1 Department of Radiodiagnosis, Saveetha Medical College and Hospital, Chennai, Tamil Nadu , (India)
Type
Published Article
Journal
Journal of Clinical Imaging Science
Publisher
Scientific Scholar
Publication Date
Dec 20, 2020
Volume
10
Identifiers
DOI: 10.25259/JCIS_134_2020
PMID: 33408961
PMCID: PMC7771397
Source
PubMed Central
Keywords
Disciplines
  • Case Series
License
Green

Abstract

Mycotic pseudoaneurysm (or infected pseudoaneurysm) is an infectious arteritis, leading to the destruction of the arterial wall with the formation of a blind, saccular outpouching contiguous with the arterial lumen. Delayed management or non-management of mycotic pseudoaneurysms is associated with high morbidity and mortality due to complications such as arterial rupture, hemorrhage, and fulminant sepsis. Earlier diagnosis of mycotic pseudoaneurysm is essential for time management. Multidetector computed tomography (MDCT) is a widely used imaging modality for detecting the mycotic pseudoaneurysm, its characterization, and vascular mapping. MDCT findings of mycotic pseudoaneurysm are blind, saccular outpouching of an artery with irregular arterial wall, perivascular soft-tissue mass, or edema. Uncommon results of MDCT include arterial lumen thrombosis, arterial wall calcification, and perivascular gas. Management of mycotic pseudoaneurysm includes endovascular stenting with graft repair, endovascular embolization, open surgery, medical therapy (intravenous antibiotics), or a combination of these. We report three cases of mycotic pseudoaneurysm affecting aortic isthmus, a segmental branch of the pulmonary artery, and the internal mammary artery. All cases posed a diagnostic challenge, which only on subsequent imaging revealed to be a mycotic pseudoaneurysm.

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