A 47 years old man with history of TB and prosthetic valve

 

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Doctor's Information

Name : Hamidreza
Family : Haghighatkhah
Affiliation :Radiology department,ShohadaTajrish Hospital,SBMU
Academic Degree : Associate professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Afsane Rashty

 

Case Section

Cardiovascular

 

Patient's Information

Gender : Male
Age : 47

 

Clinical Summary

A 47 years old man with history of TB and prosthetic valve

 

Imaging Findings

CT Angiography of aorta and its main branches: Large aneurysm with peripheral thrombosis and lobular borders is seen in preaortic area which originate from proximal part of SMA

 

Differential Diagnosis

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Final Diagnosis

Mycotic aneurysm of SMA

 

Discussion (Related Text)

Mycotic aneurysms of native vessels are rare. It is believed that such infection must be superimposed on a diseased vessel and that it occurs as a result of hematogenous or direct spread. The cause can often be difficult to determine but there may be direct bacterial i nfection of an atheromatous plaque or secondary spread from a thoracic infection such as tuberculosis. Other predisposing causes such as infected prosthetic valves or sternal wires are also important. The prognosis is poor because the aneurysm often expands quickly, leading to rupture. Superior mesenteric artery (SMA) aneurysm is the third most common splanchnic artery aneurysm, accounting for 5.5% of these lesions The prevalence of these aneurysms is the same between male and female. These aneurysms are most commonly placed at the first proximal 5cm of the artery. The most common cause of SMA aneurysm is considered to be infection; however a recent report suggested that an infectious etiology accounted for less than 5% of these aneurysms . Other causes include atherosclerosis, connective tissue disease, cystic medial necrosis, pancreatitis and trauma.SMAaneurysm is also seen with colon cancer ,lupus erythematosus and intestinal tuberculosis. Although many splanchnic artery aneurysms are asymptomatic, more than 90% of SMA aneurysms are symptomatic, with associated abdominal pain and gastrointestinal bleeding. Acute mesenteric ischemia may result from thromboembolism ofthe artery .ickly, leading to rupture.

 

References

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