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Mycotic aneurysm of the carotid artery in a chronic haemodialysis patient

Mycotic aneurysm of the carotid artery in a chronic haemodialysis patient NDT Plus (2010) 3: 95–96 doi: 10.1093/ndtplus/sfp144 Advance Access publication 10 October 2009 Images in Nephrology (Section Editor: G. H. Neild) Mycotic aneurysm of the carotid artery in a chronic haemodialysis patient Wen-Sheng Ko, Tso-Hsiao Chen and Chung-Yi Cheng Division of Nephrology, Department of Internal Medicine, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan Correspondence and offprint requests to: Chung-Yi Cheng; E-mail: resus@sparqnet.net Keywords: carotid artery; haemodialysis; mycotic aneurysm nation revealed necrosis and necrotizing inflammation in the vascular wall associated with purulent inflammatory infiltrates. Some bacterial clumps in the inflammatory in- A 69-year-old male had been receiving maintenance filtrates and necrotic vascular wall were revealed by haema- haemodialysis for end-stage diabetic nephropathy via a toxylin and eosin (H&E) staining (Figure 2). The culture of right forearm arteriovenous fistula three times a week for the resected aneurysm was positive for methicillin-resistant 7 years. He had noted left neck pain with swelling for 5 days Staphylococcus aureus (MRSA). Blood cultures yielded an before admission. On presentation, his body temperature identical strain of MRSA. was 37 C, heart rate was 92 beats/min and blood pressure A carotid mycotic aneurysm is a rare complication in was 113/76 mmHg. A physical examination revealed a pal- chronic haemodialysis patients. Arterial trauma is the pri- pable, tender, immovable and non-pulsatile mass of the left mary aetiology in 42% of all mycotic aneurysms, with an neck. No significant heart murmur or neurologic deficit increasing trend over the past four decades [1]. Multidetec- was found in the examination. The patient also had left toe tor CT angiography is the imaging modality of choice for gangrenous change with multiple ulceration wounds. The the localization and detection of the vascular lesion extent lesion had been slowly progressing over the past 6 months. and surveillance of the effectiveness of treatment [2,3]. The arteriovenous fistula over the right forearm showed no erythematous change or local heat. Conflict of interest statement. None declared. The patient’s haemoglobin was 11.5 g/dl, white blood cell count was 13 680/μl, serum creatinine was 5.0 mg/dl and C-reactive protein was 16.5 mg/dl. Neck computed tomo- References graphic (CT) angiography revealed a 5.7 × 5.2 × 3.6-mm 1. Brown SL, Busuttil RW, Baker JD et al. Bacteriologic and surgical mass lesion with internal homogeneous low-density and determinants of survival in patients with mycotic aneurysms. JVasc marginal enhancement, encasing the left common carotid Surg 1984; 1: 541–547 artery bifurcation (Figure 1). The image was compatible 2. Lee WK, Mossop PJ, Little AF et al. Infected (mycotic) aneurysms: with a ruptured left carotid aneurysm. The patient under- spectrum of imaging appearances and management. Radiographics went an emergent operation. Excision of the common to 2008; 28: 1853–1868 internal carotid artery aneurysm with an external jugular 3. Abdel-Azim TA. Infected aortic aneurysm. Acta Chir Belg 2005; 105: 482–486 vein graft bypass was performed. The pathology exami- Received for publication: 13.8.09; Accepted in revised form: 14.9.09 C The Author 2009. Published by Oxford University Press [on behalf of ERA-EDTA]. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org 96 W.-S. Ko et al. Fig. 1. CT image reconstruction showing an aneurysm encasing the left common carotid artery bifurcation (black arrow). Insert (bottom right corner): Direction and cross-sectional view of the image. Fig. 2. Bacterial clumps deposited in the necrotic vascular wall (black arrows) (H&E stain, ×200). http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Clinical Kidney Journal Oxford University Press

Mycotic aneurysm of the carotid artery in a chronic haemodialysis patient

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References (8)

Publisher
Oxford University Press
Copyright
© The Author 2009. Published by Oxford University Press [on behalf of ERA-EDTA]. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Subject
Images in Nephrology (Section Editor: G. H. Neild)
ISSN
2048-8505
eISSN
2048-8513
DOI
10.1093/ndtplus/sfp144
pmid
25984043
Publisher site
See Article on Publisher Site

Abstract

NDT Plus (2010) 3: 95–96 doi: 10.1093/ndtplus/sfp144 Advance Access publication 10 October 2009 Images in Nephrology (Section Editor: G. H. Neild) Mycotic aneurysm of the carotid artery in a chronic haemodialysis patient Wen-Sheng Ko, Tso-Hsiao Chen and Chung-Yi Cheng Division of Nephrology, Department of Internal Medicine, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan Correspondence and offprint requests to: Chung-Yi Cheng; E-mail: resus@sparqnet.net Keywords: carotid artery; haemodialysis; mycotic aneurysm nation revealed necrosis and necrotizing inflammation in the vascular wall associated with purulent inflammatory infiltrates. Some bacterial clumps in the inflammatory in- A 69-year-old male had been receiving maintenance filtrates and necrotic vascular wall were revealed by haema- haemodialysis for end-stage diabetic nephropathy via a toxylin and eosin (H&E) staining (Figure 2). The culture of right forearm arteriovenous fistula three times a week for the resected aneurysm was positive for methicillin-resistant 7 years. He had noted left neck pain with swelling for 5 days Staphylococcus aureus (MRSA). Blood cultures yielded an before admission. On presentation, his body temperature identical strain of MRSA. was 37 C, heart rate was 92 beats/min and blood pressure A carotid mycotic aneurysm is a rare complication in was 113/76 mmHg. A physical examination revealed a pal- chronic haemodialysis patients. Arterial trauma is the pri- pable, tender, immovable and non-pulsatile mass of the left mary aetiology in 42% of all mycotic aneurysms, with an neck. No significant heart murmur or neurologic deficit increasing trend over the past four decades [1]. Multidetec- was found in the examination. The patient also had left toe tor CT angiography is the imaging modality of choice for gangrenous change with multiple ulceration wounds. The the localization and detection of the vascular lesion extent lesion had been slowly progressing over the past 6 months. and surveillance of the effectiveness of treatment [2,3]. The arteriovenous fistula over the right forearm showed no erythematous change or local heat. Conflict of interest statement. None declared. The patient’s haemoglobin was 11.5 g/dl, white blood cell count was 13 680/μl, serum creatinine was 5.0 mg/dl and C-reactive protein was 16.5 mg/dl. Neck computed tomo- References graphic (CT) angiography revealed a 5.7 × 5.2 × 3.6-mm 1. Brown SL, Busuttil RW, Baker JD et al. Bacteriologic and surgical mass lesion with internal homogeneous low-density and determinants of survival in patients with mycotic aneurysms. JVasc marginal enhancement, encasing the left common carotid Surg 1984; 1: 541–547 artery bifurcation (Figure 1). The image was compatible 2. Lee WK, Mossop PJ, Little AF et al. Infected (mycotic) aneurysms: with a ruptured left carotid aneurysm. The patient under- spectrum of imaging appearances and management. Radiographics went an emergent operation. Excision of the common to 2008; 28: 1853–1868 internal carotid artery aneurysm with an external jugular 3. Abdel-Azim TA. Infected aortic aneurysm. Acta Chir Belg 2005; 105: 482–486 vein graft bypass was performed. The pathology exami- Received for publication: 13.8.09; Accepted in revised form: 14.9.09 C The Author 2009. Published by Oxford University Press [on behalf of ERA-EDTA]. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org 96 W.-S. Ko et al. Fig. 1. CT image reconstruction showing an aneurysm encasing the left common carotid artery bifurcation (black arrow). Insert (bottom right corner): Direction and cross-sectional view of the image. Fig. 2. Bacterial clumps deposited in the necrotic vascular wall (black arrows) (H&E stain, ×200).

Journal

Clinical Kidney Journal – Oxford University Press

Published: Feb 10, 2010

Keywords: Keywords carotid artery haemodialysis mycotic aneurysm

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