A Case of Mycotic Pseudoaneurysm of the Brachiocephalic Artery

(Yokohama City University Medical Center Cardiovascular Center, Yokohama, Japan and First Department of Surgery, Yokohama City University*, Yokohama, Japan)

Motohiko Goda Kiyotaka Imoto Shinichi Suzuki
Keiji Uchida Toshiki Hatsune Yoshinori Takanashi*
A 61-year-old man admitted to another hospital because of cerebral infarction had fever (about 39C). Computed tomographic scanning revealed a pseudoaneurysm of the brachiocephalic artery, accompanied by pericardial fluid. The patient was transferred to our hospital. Culture studies of a sample of pericardial fluid revealed Staphylococcus aureus. A mycotic pseudoaneurysm of the brachiocephalic artery was diagnosed. Antibiotics were given for about 2 weeks after transfer to our hospital. Surgery was performed after the inflammation subsided. The pseudoaneurysm was incised during circulatory arrest. A hole measuring 2 cm in diameter was found at the origin of the brachiocephalic artery. The hole was sealed with an autologous arterial patch, made from a 3-cm section of the right axillary artery. The axillary artery was reconstructed by end-to-end anastomosis. After surgery, infection was controlled by means of systemic antibiotics and closed mediastinal lavage. The patient was discharged from the hospital in good condition 160 days after surgery. To date, there has been no flare-up of infection.
@Jpn. J. Cardiovasc. Surg. 35: 164-167 (2006)