CTICasesMycotic Aortic Aneurysm
Imaging findings
CTA of the chest in a patient with a history of intravenous drug abuse and Staphylococcus aureus bacteremia demonstrates a massive, wide-mouthed pseudoaneurysm arising from the aortic arch, with extensive surrounding soft-tissue thickening and hematoma consistent with rupture. The patient underwent transverse hemi-arch replacement and carotid-subclavian bypass.
Key takeaways
Mycotic (infectious) aortic aneurysms are rare, highly unstable cardiovascular infections, most commonly caused by bacterial seeding (e.g., S. aureus) of the aortic wall in the setting of IV drug abuse or endocarditis. They present as rapidly enlarging, lobulated pseudoaneurysms that carry an extremely high risk of free rupture and death, necessitating emergency surgical replacement and prolonged antibiotic therapy.
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