PDF(Pubmed)
Abstract：
BACKGROUND: A splenic artery pseudoaneurysm is a rare pathology that occurs mainly secondary to pancreatitis, abdominal trauma, peptic ulcers, pancreatic and gastric cancers, and infections. It is best diagnosed using computed tomography angiography and typically treated using endovascular embolization and, in some cases, open or laparoscopic surgery. In this report, we present a case of a ruptured mycotic splenic artery pseudoaneurysm containing Histoplasma capsulatum, which to our knowledge is the first case to report a mycotic splenic artery pseudoaneurysm of this nature.
METHODS: We report a case of a 42-year-old white male with past medical history of Hepatitis C and IV drug abuse who presented to the Emergency Department with a 24-h history of severe diffuse abdominal pain. He was tachycardic and peritonitic on exam. Work-up demonstrated leukocytosis and lactic acidosis. Computed tomography of the abdomen and pelvis with intravenous contrast showed hemoperitoneum and active extravasation of contrast from the splenic artery into the splenic hilum, associated with a surrounding hematoma measuring 5.3 × 5.0 cm, concerning for ruptured splenic artery pseudoaneurysm. The patient was taken emergently for exploratory laparotomy, where a large intraperitoneal hematoma was evacuated. A ruptured splenic artery pseudoaneurysm was identified, isolated, and controlled, followed by completion splenectomy. Final pathology demonstrated a 3.0 × 1.3 × 0.3 cm pseudoaneurysm wall and a 14 × 9.5 × 5.5 cm spleen containing multiple necrotizing granulomata positive for the presence of Histoplasmosis species. The patient recovered appropriately and was discharged on post-operative day five.
CONCLUSIONS: This case demonstrates a successful approach to a ruptured mycotic splenic artery pseudoaneurysm resulting in a positive outcome. It is a unique case as it highlights, to our knowledge, the first report of splenic artery aneurysm secondary to Histoplasma capsulatum infection. This report helps further the understanding of the pathophysiology as well as the natural history of mycotic splenic pseudoaneurysms.
METHODS: We report a case of a 42-year-old white male with past medical history of Hepatitis C and IV drug abuse who presented to the Emergency Department with a 24-h history of severe diffuse abdominal pain. He was tachycardic and peritonitic on exam. Work-up demonstrated leukocytosis and lactic acidosis. Computed tomography of the abdomen and pelvis with intravenous contrast showed hemoperitoneum and active extravasation of contrast from the splenic artery into the splenic hilum, associated with a surrounding hematoma measuring 5.3 × 5.0 cm, concerning for ruptured splenic artery pseudoaneurysm. The patient was taken emergently for exploratory laparotomy, where a large intraperitoneal hematoma was evacuated. A ruptured splenic artery pseudoaneurysm was identified, isolated, and controlled, followed by completion splenectomy. Final pathology demonstrated a 3.0 × 1.3 × 0.3 cm pseudoaneurysm wall and a 14 × 9.5 × 5.5 cm spleen containing multiple necrotizing granulomata positive for the presence of Histoplasmosis species. The patient recovered appropriately and was discharged on post-operative day five.
CONCLUSIONS: This case demonstrates a successful approach to a ruptured mycotic splenic artery pseudoaneurysm resulting in a positive outcome. It is a unique case as it highlights, to our knowledge, the first report of splenic artery aneurysm secondary to Histoplasma capsulatum infection. This report helps further the understanding of the pathophysiology as well as the natural history of mycotic splenic pseudoaneurysms.
摘要：
背景：脾动脉假性动脉瘤是一种罕见的病理，主要继发于胰腺炎，腹部创伤,消化性溃疡,胰腺癌和胃癌，和感染。最好使用计算机断层扫描血管造影进行诊断，通常使用血管内栓塞进行治疗，在某些情况下,开腹或腹腔镜手术。在这份报告中,我们介绍了一例破裂的霉菌性脾动脉假性动脉瘤，其中含有组织胞浆，据我们所知，这是第一个报告这种性质的真菌性脾动脉假性动脉瘤的病例。
方法：我们报告了一例42岁的白人男性，既往有丙型肝炎和IV药物滥用史，他到急诊科就诊，有24小时的严重弥漫性腹痛史。他检查时心动过速和腹膜炎。检查显示白细胞增多和乳酸性酸中毒。腹部和骨盆的计算机断层扫描与静脉造影显示腹膜积血和从脾动脉到脾门的造影剂的积极外渗。与周围血肿相关，大小为5.3×5.0厘米，考虑脾动脉假性动脉瘤破裂。患者被紧急采取剖腹探查术，一个巨大的腹膜内血肿被疏散。发现脾动脉假性动脉瘤破裂，孤立的,和控制,然后完成脾切除术。最终病理显示3.0×1.3×0.3cm假性动脉瘤壁和14×9.5×5.5cm脾脏，其中包含多个坏死性肉芽肿，对组织胞浆菌病物种的存在呈阳性。患者恢复良好，术后第5天出院。
结论：该病例证明了一个成功的方法来治疗破裂的真菌性脾动脉假性动脉瘤，结果是积极的。这是一个独特的案例，因为它突出了，根据我们的知识，首次报告的脾动脉瘤继发于荚膜组织支原体感染。该报告有助于进一步了解霉菌性脾假性动脉瘤的病理生理学和自然史。
方法：我们报告了一例42岁的白人男性，既往有丙型肝炎和IV药物滥用史，他到急诊科就诊，有24小时的严重弥漫性腹痛史。他检查时心动过速和腹膜炎。检查显示白细胞增多和乳酸性酸中毒。腹部和骨盆的计算机断层扫描与静脉造影显示腹膜积血和从脾动脉到脾门的造影剂的积极外渗。与周围血肿相关，大小为5.3×5.0厘米，考虑脾动脉假性动脉瘤破裂。患者被紧急采取剖腹探查术，一个巨大的腹膜内血肿被疏散。发现脾动脉假性动脉瘤破裂，孤立的,和控制,然后完成脾切除术。最终病理显示3.0×1.3×0.3cm假性动脉瘤壁和14×9.5×5.5cm脾脏，其中包含多个坏死性肉芽肿，对组织胞浆菌病物种的存在呈阳性。患者恢复良好，术后第5天出院。
结论：该病例证明了一个成功的方法来治疗破裂的真菌性脾动脉假性动脉瘤，结果是积极的。这是一个独特的案例，因为它突出了，根据我们的知识，首次报告的脾动脉瘤继发于荚膜组织支原体感染。该报告有助于进一步了解霉菌性脾假性动脉瘤的病理生理学和自然史。
