Mycotic aneurysm of descending thoracic aorta

Seit Mei CHIEN ¹ and S SANKARAKUMAR ².

¹ Medical School, University of Glasgow, Scotland, ² Department of Radiology, RIPAS Hospital, Brunei Darussalam

ABSTRACT

Mycotic aneurysm has become rare since the introduction of penicillin. However, clinicians should be aware and consider the possibility as delayed treatment can lead to poor outcomes. We report the case of a 23-year-old Malay lady with congenital scoliosis presenting with back pain and fever. Computer tomography scan showed a large pseudo-aneurysm of descending thoracic aorta and a smaller pseudo-aneurysm affecting the intercostal artery secondary to vertebral osteomyelitis. Blood culture isolated Staphylococcus aureus. She was treated with embolisation using custom-made coils and N-butyl-cyanoacrylate glue as temporary measure before eventually proceeding to surgery. Unfortunately, the surgery was complicated by bleeding secondary to the severely inflamed aorta resulting in her demise.

Keywords: Aneurysm, bacterial, osteomyelitis, complications, endo-vascular therapy

Correspondence author: S Sankarakumar, Department of Radiology, RIPAS Hospital, Bandar Seri Begawan BA 1710, Brunei Darussalam.

Tel: +673 2242424 Ext 6308, Fax: +673 2242690

E mail: drsankarakumar@gmail.com

Brunei Int Med J. 2013; 9 (2): 126-130