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.

Mycotic thoracic aortic aneurysm (MTAA) is a disease that is difficult to treat and often lethal. Open repair has high morbidity and mortality risks; additionally, thoracic endovascular aneurysm repair (TEVAR) often requires innovative techniques. We report the use of an innominate artery chimney endovascular aneurysm repair (ChEVAR) with carotid-carotid and carotid-left subclavian artery bypass for a time-sensitive Salmonella-related MTAA. A symptomatic type 1a endoleak was discovered and promptly and successfully treated. This report shows that the use of innominate artery ChEVAR to treat MTAA is feasible and safe, although the procedure is rarely performed, even in large series. We hypothesize that prophylactic gutter embolization is a feasible option in view of the high endoleak risks in such cases, although further evidence is required to support this.

UNASSIGNED: Pulmonary artery aneurysms encompass a wide range of presentations and forms. Mycotic aneurysms represent a particular subset of focal dilatation of the vessel wall with high morbidity and mortality rates. Herein, we report the case of a 32 year old patient, with a prior history of ventricular septal defect presenting with a mycotic pulmonary artery aneurysm associated with infective endocarditis and septic emboli.
UNASSIGNED: We present the case of a 32 year old male with known history of congenital ventricular septal defect presented to the emergency department with signs of sepsis and dyspnea. Blood cultures were positive for methicillin-sensitive Staphylococcus aureus. An echocardiogram found evidence of endocarditis with multiples intra cavitary vegetations. A CT angiogram demonstrated major right ventricular dilatation, multiple nodules and peripheral opacities, scattered throughout the lungs, indicative of septic emboli. Segmental saccular dilatation of the left lateral basal pulmonary artery consistent with a mycotic aneurysm formation was found. The patient was started on intravenous antibiotics and given the overall satisfactory evolution a conservative approach was pursued. The patient was discharged with antibiotics and scheduled for surgical repair of the ventricular septal defect.
UNASSIGNED: To our knowledge, mycotic aneurysms associated to congenital heart malformation like ventricular septal wall defect remains a rare condition with few reported cases in the literature. Being aware of this entity is important for every practicing radiologist to allow for early diagnosis and treatment.

Mycotic pseudoaneurysms can be a serious and life threatening complication of left sided infective endocarditis. They most commonly affect the major axial vessels. Profunda femoris artery (PFA) aneurysms are rare and present in only 0.5% of all peripheral aneurysms, regardless of the underlying etiology. We present a case of a patient who underwent mitral valve repair for severe mitral regurgitation secondary to culture negative IE which was complicated by multiple mycotic pseudoaneurysm. The PFA pseudoaneurysm which was affected and was complicated with a large hematoma compressing the femoral nerve. This was managed by a staged hybrid approach. Endovascular stenting was performed first to seal the pseudoaneurysm and facilitate open surgical repair using a reversed interposition saphenous vein graft. To the best of our knowledge, this is the first reported case of a PFA mycotic aneurysm (MA) being managed by a hybrid approach using endo-vascular and open surgical repair. MAs and pseudoaneurysms are complex and life threatening conditions requiring meticulous planning for optimal management. Endovascular stenting can be considered as an alternative to surgical management in certain cases or as a bridge to definitive open surgical repair depending on anatomical location and associated complications.

BACKGROUND: Coronary stent infections are an uncommon but deadly complication of percutaneous coronary intervention. Mortality remains as high as 40-60% even with adequate treatment. We report such an interesting case of left circumflex stent (LCX) infection and mycotic aneurysm that was successfully managed with antibiotics and surgery.
METHODS: A middle-aged man who underwent percutaneous coronary intervention (PCI) to the left circumflex artery four weeks prior was referred as a case of pyrexia of unknown origin, not responding to antibiotics, and colchicine started for suspected Dressler syndrome. Although the inflammatory markers were elevated, the results of the blood culture did not show any growth. Echocardiography showed a doubtful echogenic structure in the left atrioventricular groove and mild pericardial effusion, and a stent infection was suspected. PET scan showed focal metabolic activity in the region of the LCX stent, with metabolically active supraclavicular and paratracheal lymph nodes, and a coronary angiogram revealed an aneurysm arising distal to the stented LCX. A diagnosis of stent infection and associated mycotic aneurysm was made, and the patient underwent surgery which included aneurysm repair, stent retrieval, and coronary artery bypass graft (CABG) to the major and terminal OM. The postoperative course was uneventful, and the patient was discharged without complications.
CONCLUSIONS: It is important to investigate the possibility of coronary stent infection in individuals experiencing prolonged fever following PCI. PET scans and coronary angiograms can aid in diagnosis when echocardiograms are inconclusive. Adequate antibiotic therapy and timely surgery are crucial for successfully managing coronary stent infections.

UNASSIGNED: As only early diagnosis, prompt surgical intervention, and appropriate antibiotic therapy can decrease clostridial MAA mortality rate; keeping in mind a broad differential diagnosis in a patient with sepsis and unusual vascular symptoms is important.
UNASSIGNED: Mycotic aortic aneurysm (MAA) is an infrequent but very consequential condition characterized by the pathological disruption of the aorta due to infection. Clostridium perfringens is a bacterium that falls under the taxonomic classification of the genus Clostridium. Although mycotic aneurysm is often not commonly linked with this infection, there are instances when it may function as a causative agent for MAA. Timely diagnosis and thorough therapeutic techniques, including surgical intervention and quick administration of appropriate antibiotics, can potentially reduce the mortality rate associated with clostridial MAA. In this study, we presented a clinical report detailing the diagnosis of a mycotic aneurysm caused by C. perfringens in the thoracic aorta in a 66-year-old male patient with a history of diabetes mellitus and a recent prostate biopsy. Furthermore, we discussed the surgical approach and overall management strategy to address this case.

Metastatic infections can complicate catheter-related blood stream infections (CRBSI) in dialysis dependent patients. However, an infected/septic aneurysm involving the aorta or its branches as a direct complication of CRBSI without an underlying infective endocarditis is not reported so far in the literature. We report a 43-year female, who presented with CRBSI 2 weeks following a tunneled dialysis catheter (TDC) insertion. Due to the lack of defervescence after 72 h of antibiotics given as per the culture sensitivity reports, the TDC was removed. Blood cultures grew Pseudomonas aeruginosa. After a catheter free interval of 4 days, a TDC was reinserted, an antibiotic course was completed, and she was discharged in stable condition. Five days later, she presented with acute abdominal pain and fever. A tender, firm, and pulsatile mass was noted in the hypogastrium with a bruit. Contrast-enhanced CT revealed a pseudoaneurysm of the aorta, and left common iliac artery at the site of origin. She was started on IV antibiotics and planned for an endovascular prosthesis but had a sudden collapse during her hospital stay due to a ruptured aneurysm. CRBSI due to certain pathogens such as Pseudomonas might require prolonged and dual antibiotic therapy to prevent fulminant complications.

BACKGROUND: Aortic mycotic aneurysms are a rare but life-threatening condition and may be associated with aorto-bronchial- and aorto-esophageal fistulas. Although both very rare, they carry a high mortality and require (urgent) surgical intervention. Surviving all three conditions concomitantly is extraordinary. We describe a patient who underwent staged repair of such combined defects.

A 74-year-old woman with a history of mitral valve prolapse with mitral regurgitation was transferred to our hospital due to infective endocarditis. Blood culture revealed Abiotrophia defectiva which is known as a nutritional variant streptococcus. Transesophageal echocardiography revealed posterior leaflet (P2) prolapse due to rupture of tendon chordae with severe mitral regurgitation and vegetation on posterior leaflet. Magnetic resonance imaging (MRI) revealed multiple infarction lesions in left temporal lobe and parietal lobe and mycotic aneurysm formation of right middle cerebral artery. Because A. defectiva cannot be cultured on non-supplemented media, their prevalence may be underreported.
UNASSIGNED: A number of causative microorganisms of infective endocarditis have been identified. Streptococci and staphylococci account for 80 % of cases of infective endocarditis. Abiotrophia defectiva does not grow in ordinary growth media and its prevalence may be underreported. It is important to know A. defectiva causes infective endocarditis with mycotic aneurysm formation.

Aortoesophageal fistula (AEF) is a rare cause of upper gastrointestinal bleeding that often receives little attention in the emergency department. The classic presentation includes the Chiari triad of central chest pain, sentinel arterial bleeding, and subsequent evacuation after an asymptomatic period. For patients suspected of having AEF, a CT scan with IV contrast is the preferred diagnostic modality. In our patient, the presence of an aortic wall outpouching, ectopic gas, periaortic fat stranding, and leukocytosis, even in the absence of fever and positive blood culture, suggested mycotic aneurysm with AEF. The unique aspect of this case report is the occurrence of AEF as a rare complication of endoscopic procedures, which should be considered. Treatment options for AEF include surgery and thoracic endovascular aortic repair (TEVAR). TEVAR is a good option for stabilizing the patient\'s condition and reducing mortality in the short term. Once the patient\'s condition is suitable for AEF repair surgery, surgical intervention can be performed.