CTICasesCoxiella burnetii Abscess around Aortic Endograft
Imaging findings
CT in a patient with prior aortic stent graft placement demonstrates a thick-walled, rim-enhancing fluid collection with internal debris and a small retained pledget or suture material adjacent to the endograft in the mediastinum, abutting the esophagus. Esophagogram showed extrinsic mass effect without fistula. Surgical drainage confirmed the organism as Coxiella burnetii (Q fever).
Key takeaways
Coxiella burnetii (the agent of Q fever) is an extremely rare cause of prosthetic vascular graft infection and mediastinal abscess. A retained surgical pledget or suture adjacent to the graft may serve as a nidus for infection. Graft infections are often clinically insidious and may present with low-grade fever and dysphagia. CT identification of a retained pledget or suture in an abscess cavity adjacent to a vascular graft is a critical diagnostic clue. Long-term doxycycline-based antibiotic therapy is required.
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