Infected (Mycotic) aneurysms: Spectrum of imaging appearances and management

Wai Kit Lee, Peter J. Mossop, Andrew F. Little, Gregory J. Fitt, John I. Vrazas, Jenny K. Hoang, Oliver F. Hennessy

Research output: Contribution to journalArticle

Abstract

Infected aneurysms are uncommon. The aorta, peripheral arteries, cerebral arteries, and visceral arteries are involved in descending order of frequency. Staphylococcus and Streptococcus species are the most common causative pathogens. Early clinical diagnosis of infected aneurysms is challenging owing to their protean manifestations. Clinically apparent infected aneurysms are often at an advanced stage of development or are associated with complications, such as rupture. Nontreatment or delayed treatment of infected aneurysms often has a poor outcome, with high morbidity and mortality from fulminant sepsis or hemorrhage. Current state-of-the-art imaging modalities, such as multidetector computed tomography and magnetic resonance imaging, have replaced conventional angiography as minimally invasive techniques for detection of infected aneurysms in clinically suspected cases, as well as characterization of infected aneurysms and vascular mapping for treatment planning in confirmed cases. Doppler ultrasonography allows noninvasive assessment for infected aneurysms in the peripheral arteries. Imaging features of infected aneurysms include a lobulated vascular mass, an indistinct irregular arterial wall, perianeurysmal edema, and a perianeurysmal soft-tissue mass. Perianeurysmal gas, aneurysmal thrombosis, aneurys-mal wall calcification, and disrupted arterial calcification at the site of the infected aneurysm are uncommon findings. Imaging-guided endovascular stentgraft repair and embolotherapy can be performed in select cases instead of open surgery. Familiarity with the imaging appearances of infected aneurysms should alert the radiologist to the diagnosis and permit timely treatment, which may include endovascular techniques.

Original languageEnglish (US)
Pages (from-to)1853-1868
Number of pages16
JournalRadiographics
Volume28
Issue number7
DOIs
StatePublished - Nov 1 2008
Externally publishedYes

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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    Lee, W. K., Mossop, P. J., Little, A. F., Fitt, G. J., Vrazas, J. I., Hoang, J. K., & Hennessy, O. F. (2008). Infected (Mycotic) aneurysms: Spectrum of imaging appearances and management. Radiographics, 28(7), 1853-1868. https://doi.org/10.1148/rg.287085054