Successful Treatment of a Rapidly-Expanding Infected Thoracic Aortic Aneurysm with Streptococcus pneumonia

Makoto Hamaishi

Kenji Okada

Shinji Hirai and Norimasa Mitsui

（Department of Cardiovascular and Respiratory Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan）

An 83-year-old woman who had an attack of fever, fatigue, and lumbar pain was hospitalized as an emergency. Detailed investigations revealed that she had urinary infection, infectious spondylitis, and bacteremia with Streptococcus pneumonia, for which she received antimicrobial therapy. After 12 days in hospital, enhanced computed tomography showed that the aortic arch had expanded, with fluid collection. Though there had been no imaging findings by computed tomography scan on admission. We thought this was an infected thoracic aortic aneurysm with Streptococcus pneumonia, and continued to administer the antibiotic drugs for infection control. After 14 days in hospital, she developed hoarseness and complained of severe back pain. Emergency computed tomography scan showed that the aortic arch had further expanded to 66 mm in size and that much more fluid had collected. We decided it was an impending rupture of the rapidly-expanding infected thoracic aortic aneurysm, and we then performed an emergency operation. The infected portion of the thoracic aorta was resected. The ascending, arch, and descending portions of the aorta were replaced with rifampicin-bonded synthetic graft, and then omental wrapping was performed. Antimicrobial administration was continued after surgery. The postoperative course was uneventful. The infection was successfully controlled. She was discharged without complications. No signs of recurrent infection have been observed for 1 year and 6 months after operation.

 

Jpn. J. Cardiovasc. Surg. 44:159-164（2015）

Keywords：infected aortic aneurysm;thoracic aortic aneurysm;Streptococcus pneumonia