Mycotic Aneurysm of the Aorta in a Patient with Coarctation and Endothelitis
J. Wirbelauer1, U. Kramer2, L. Sieverding3
1University Children's Hospital, Wuerzburg, Germany (Director: Prof. Dr. Ch. P. Speer),
2University Hospital, Department of Radiology, Tuebingen, Germany (Director: Prof. Dr. C. Claussen),
3University Children's Hospital, Department of Pediatric Cardiology, Tuebingen, Germany (Director: Prof. Dr. M. Hofbeck)
Coarctation of the aorta can be subdivided into two groups. The so called "preductal" type is a well-known cause of heart-failure in neonates. Aortic coarctation of the "postductal" or adult type is associated with collateral artery development and may be missed in the first or second decades of life.
We report the case of an 8 year old boy who was admitted to our hospital acutely ill due to staphylococcus aureus septicaemia, which was complicated by splenic abscesses. A clinical diagnosis of aortic coarctation was confirmed by echocardiography. An endothelitis of the stenotic segment was suspected as being the source of septicaemia. Prior to a planned surgical intervention a cardiovascular magnetic-resonance-imaging study was performed (Figure 1). This revealed a huge saccular aortic aneurysm in the area of the coarctation. Such aneurysms are a known complication of aortic coarctation in childhood. In this case it is important to note that this aneurysm could not be found by echocardiography despite knowing the results of the MRI-scan. The stenotic segment, including the aneurysm, was successfully resected and replaced by an aortic homograft. Removal of the spleen was avoided. Subsequent pathological examination showed that the aneurysm was located at the site of origin of a large intercostal collateral artery from the proximal descending aorta. Infective involvement of the resected segment was proven on histology.
Figure legend
Figure 1. Sagittal-scan of the thorax showing a huge saccular aneurysm (?) originating from the proximal descending thoracic aorta (AOD). Perfusion with contrast-medium demonstrates connection of the aneurysm with the vascular lumen.
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