Infected aneurysms are uncommon. The aorta, peripheral arteries, cerebral arteries, and visceral arteries are involved in descending order of frequency. Staphylococcus and Streptococcus species are the most common causative pathogens. Early clinical diagnosis of infected aneurysms is challenging owing to their protean manifestations. Clinically apparent infected aneurysms are often at an advanced stage of development or are associated with complications, such as rupture. Nontreatment or delayed treatment of infected aneurysms often has a poor outcome, with high morbidity and mortality from fulminant sepsis or hemorrhage. Current state-of-the-art imaging modalities, such as multidetector computed tomography and magnetic resonance imaging, have replaced conventional angiography as minimally invasive techniques for detection of infected aneurysms in clinically suspected cases, as well as characterization of infected aneurysms and vascular mapping for treatment planning in confirmed cases. Doppler ultrasonography allows noninvasive assessment for infected aneurysms in the peripheral arteries. Imaging features of infected aneurysms include a lobulated vascular mass, an indistinct irregular arterial wall, perianeurysmal edema, and a perianeurysmal soft-tissue mass. Perianeurysmal gas, aneurysmal thrombosis, aneurysmal wall calcification, and disrupted arterial calcification at the site of the infected aneurysm are uncommon findings. Imaging-guided endovascular stent-graft repair and embolotherapy can be performed in select cases instead of open surgery. Familiarity with the imaging appearances of infected aneurysms should alert the radiologist to the diagnosis and permit timely treatment, which may include endovascular techniques.

Infected (mycotic) aneurysms: spectrum of imaging appearances and management

Abdominal aortic aneurysms (AAAs) are defined as focal dilatations of the abdominal aorta that are 50% greater than the proximal normal segment or when it is more than 3 cm in maximum diameter. The early diagnosis and treatment is very important to prevent catastrophic complications. Due to its ability to assess the peri-aortic soft tissue and the exact extension of aneurysm, as well as its excellent vascular opacification and multiplanar reconstruction capabilities, computed tomography angiography (CTA) has become an integral part of the evaluation of AAA and has virtually replaced conventional angiography for the evaluation of AAA. Knowledge of the characteristic imaging features of AAA is essential for the prompt diagnosis of life-threatening complications. In this pictorial essay, we will discuss the CTA findings in AAA and its complications including rupture, infection, aorto-enteric fistula and aorto-caval fistula.

/pdf/abdominal-aortic-aneurysm-pictorial-review-of-common-5cuunbilsv.pdf

Abdominal aortic aneurysm: pictorial review of common appearances and complications.

Aortic infections are uncommon clinical entities, but are associated with high rates of morbidity and mortality. In this review, we focus on the cross-sectional imaging appearance of aortic infections, including aortic valve endocarditis, pyogenic aortitis, mycotic aneurysm and aortic graft infections, with an emphasis on CT, MRI and PET/CT appearance. Teaching Points
 • Aortic infections are associated with high morbidity and mortality.
 • CT, MRI and FDG PET/CT play complementary roles in aortic infection imaging.
 • Radiologists should be vigilant for aortic infection manifestations to ensure timely diagnosis.

/pdf/cross-sectional-imaging-of-aortic-infections-4afpvkmcjm.pdf

Cross-sectional imaging of aortic infections

Background and purpose Mycotic aneurysm poses a high risk of mortality. This study evaluated the demographic and clinical characteristics and outcomes of hospitalized patients with mycotic aneurysm. Methods Patients with mycotic aneurysm hospitalized between March 1996 and May 2006 at a medical center in southern Taiwan were retrospectively analyzed. Results Fifty two patients (38 men and 14 women; mean age, 64.5 +/- 15.6 years) were included. The leading underlying diseases were diabetes mellitus (40.4%), hypertension (21.2%), and renal disease and heart disease (19.2% each). The most common pathogens isolated from blood and/or resected tissue were Salmonella spp. (34.6%), Klebsiella pneumoniae (11.5%) and Staphylococcus aureus (11.5%). Mycotic aneurysms caused by Gram-negative bacilli were significantly more likely to occur in older patients (p=0.018) and at infrarenal sites (p=0.021). There were trends suggesting that mycotic aneurysms were more likely to be caused by Gram-negative bacilli in patients receiving steroid treatment and in those with underlying diabetes mellitus. Mycotic aneurysms caused by Gram-positive cocci were significantly more likely to occur in suprarenal arteries (p=0.048), especially intracranially (p=0.002), in younger patients (p=0.018) and in patients with concurrent endocarditis (p=0.008). The overall in-hospital mortality rate was 30.6%, and there was no significant difference in in-hospital mortality between mycotic aneurysms caused by Gram-negative bacilli and those due to Gram-positive cocci. Conclusions The relationship between the anatomic site of mycotic aneurysm and the spectrum of culprit bacteria may help clinicians promptly choose appropriate antibiotic regimens on an empirical basis. Further study is required to understand better the role of K. pneumoniae in mycotic aneurysm in Taiwan.

Clinical and microbiological characteristics of mycotic aneurysms in a medical center in southern Taiwan.

Not just an aneurysm, but an infected one: a case report and literature.

Infected aortic aneurysm is an uncommon life-threatening disease that exposes the patient to uncontrolled sepsis and aortic rupture. Infected aortic aneurysm is defined as a lesion of the arterial wall due to bacterial contamination. Two main routes have been described that can result in an infected aneurysm. The first route refers to cases in which there is a source of septic emboli or bacteremia. Endocarditis, in the preantibiotic era, was the classic source of septic emboli; intravenous drug abuse is the current leading cause. The second route refers to cases of extraaortic infection, such as spondylodiscitis, with secondary invasion of adjacent aorta. The most common organisms causing infected aortic aneurysms in recent years are Staphylococcus aureus, Salmonella, Escherichia coli, and Pseudomonas [1, 2]. Clinical diagnosis of infected abdominal aortic aneurysms is based on the presence of signs and symptoms of infection (fever, leukocytosis, and abdominal or back pain) combined with a pulsatile mass [2, 3]. Patients with such symptoms are often referred for computed tomography (CT) to exclude an abscess, diverticulitis, or other potential infectious focus. We present the CT features of infected aortic aneurysms including early-stage features, advanced-stage features, and complications. Early-stage features

Infected aortic aneurysms: CT features

Objectifs Connaitre l’anatomie normale de la region de la graisse de Hoffa et presenter de facon didactique les differentes pathologies rencontrees. Materiels et methodes Etude retrospective d’explorations radiologiques du genou a partir de la base de donnees de notre service. Resultats La graisse de Hoffa est une structure intra-capsulaire mais extra-synoviale. Elle est visualisee en pratique courante lors des IRM du genou. Elle est rarement etudiee dans la litterature, cependant elle est frequement le siege de pathologies. Ces dernieres sont le plus souvent la consequence de traumatismes ou de lesions degeneratives, mais les pathologies inflammatoires et tumorales de la synoviale peuvent egalement etre confinees dans la graisse de Hoffa. Conclusion Cette presentation didactique a pour but de presenter l’ensemble des pathologies de la graisse de Hoffa visibles en imagerie.

OA24 Imagerie de la graisse de Hoffa : aspect normal et aspect pathologique

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Infected aortic aneurysms: CT features

OA24 Imagerie de la graisse de Hoffa : aspect normal et aspect pathologique