Figure 1
Teaching Case
SectionCardiovascular
Case TypeClinical Cases
AuthorsNicholson AA
Connected authors
42 years, male
Presented with dyspnoea, rigors and diabetic ketoacidosis.
Mycotic pseudoaneurysm of the right 3rd Lumbar Artery.
The patient presented with dyspnoea, rigors and diabetic ketoacidosis. He was not known to be a diabetic. Hb was 12.3g/dl and the WCC was high.
CXR revealed consolidation at the left base and several small cavitating opacities.
A diagnosis of septicaemia and multiple chest abscesses was made. A staphylococcus was grown from a venous blood sample. The patient was appropriately treated but the following day he became tachycardic and hypotensive. Hb had fallen to 8g/dl; he started to complain of back pain and had signs of psoas muscle irritation. Endoscopy revealed a small non bleeding gastric ulcer.
The patient underwent Rx examination of the lumbar spine, CT and angiography.
CXR revealed consolidation at the left base and several small cavitating opacities.
A diagnosis of septicaemia and multiple chest abscesses was made. A staphylococcus was grown from a venous blood sample. The patient was appropriately treated but the following day he became tachycardic and hypotensive. Hb had fallen to 8g/dl; he started to complain of back pain and had signs of psoas muscle irritation. Endoscopy revealed a small non bleeding gastric ulcer.
The patient underwent Rx examination of the lumbar spine, CT and angiography.
Mycotic aneurysms have been reported in most arteries including the lumbar arteries. However when associated with psoas abscesses they are usually due to aortic aneurysms. In this case the aneurysm was truly mycotic and the psoas abscess was mainly infected haematoma. The aneurysm was embolised with 2x3mm fibered platinum coils with a good result. The 2nd and 5th right Lumbar Arteries and the Ascending Lumbar Artery were checked and collaterals shown to be occluded. A needle in the psoas revealed haematoma only. No pus was aspirated.
References
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[2]
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[3]
Louagie YA, de Canniere L, Donckier J, Reymond M, Evrard P, Weber E, Randour P, Eucher P, Buche M, Schoevaerdts JC.
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Journal of Vascular & Interventional Radiology. 6(6):876-8, 1995. (PMID: 8850663)
Case information
| URL: | https://www.eurorad.org/case/2287 |
| DOI: | 10.1594/EURORAD/CASE.2287 |
| ISSN: | 1563-4086 |
