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A 61-year-old man, with previous endovascular stenting from distal aortic arch to below the diaphragm for subacute type B aortic dissection in 2010, presented with acute coronary syndrome and subsequently developed intravenous line infection on day 5 of admission. He also described a dull ache in the mid scapular region at the same time while he developed the intravenous line infection. He had ongoing Staphylococcus aureus bacteraemia despite intravenous antibiotics. Transoesophageal echocardiogram showed no vegetations. Contrast CT chest (Panel B and C) demonstrated a soft tissue rind (yellow arrows) around the descending thoracic aorta stent (red arrow) from the level of the 4th thoracic vertebra down to the aortic hiatus, which was new in comparison to the previous scan performed 12 months earlier (Figure A). The appearances were suggestive of an infected endovascular stent with abscess formation. Surgery was not an option, due to multiple medical comorbidities and abscess were unable to be drained percutaneously. He continued to deteriorate and eventually passed away. This report illustrates the diagnostic capability of CT in providing incremental information about the complications associated with prosthetic aortic graft infection for guiding treatment.Learning Points Prosthetic aortic graft infections represent a major diagnostic and therapeutic challenge associated with considerable morbidity and mortality. Computed tomography (CT) is the imaging modality of choice in the investigation of patients with suspected prosthetic aortic graft infection Figure: A: There was no soft tissue thickening around the thoracic stent on the previous scan performed 12 months earlier.Figure B: Contrast CT chest demonstrated a soft tissue rind (yellow arrows) around the descending thoracic aorta stent (red arrow)Figure C: Again, there was soft tissue thickening (yellow arrows) around the descending thoracic aorta stent noted on contrast CT chest on the sagittal plane.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Jen-Li Looi, Department of Cardiology, Middlemore Hospital, Private Bag 933111, Otahuhu, Auckland, New Zealand; Ruvin Gabriel, Department of Cardiology, Middlemore Hospital, Private Bag 933111, Otahuhu, Auckland, New Zealand.

Acknowledgements

Correspondence

Jen-Li Looi, Department of Cardiology, Middlemore Hospital, Private Bag 93311, Otahuhu, Auckland, New Zealand.

Correspondence Email

JenLi.Looi@middlemore.co.nz

Competing Interests

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

A 61-year-old man, with previous endovascular stenting from distal aortic arch to below the diaphragm for subacute type B aortic dissection in 2010, presented with acute coronary syndrome and subsequently developed intravenous line infection on day 5 of admission. He also described a dull ache in the mid scapular region at the same time while he developed the intravenous line infection. He had ongoing Staphylococcus aureus bacteraemia despite intravenous antibiotics. Transoesophageal echocardiogram showed no vegetations. Contrast CT chest (Panel B and C) demonstrated a soft tissue rind (yellow arrows) around the descending thoracic aorta stent (red arrow) from the level of the 4th thoracic vertebra down to the aortic hiatus, which was new in comparison to the previous scan performed 12 months earlier (Figure A). The appearances were suggestive of an infected endovascular stent with abscess formation. Surgery was not an option, due to multiple medical comorbidities and abscess were unable to be drained percutaneously. He continued to deteriorate and eventually passed away. This report illustrates the diagnostic capability of CT in providing incremental information about the complications associated with prosthetic aortic graft infection for guiding treatment.Learning Points Prosthetic aortic graft infections represent a major diagnostic and therapeutic challenge associated with considerable morbidity and mortality. Computed tomography (CT) is the imaging modality of choice in the investigation of patients with suspected prosthetic aortic graft infection Figure: A: There was no soft tissue thickening around the thoracic stent on the previous scan performed 12 months earlier.Figure B: Contrast CT chest demonstrated a soft tissue rind (yellow arrows) around the descending thoracic aorta stent (red arrow)Figure C: Again, there was soft tissue thickening (yellow arrows) around the descending thoracic aorta stent noted on contrast CT chest on the sagittal plane.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Jen-Li Looi, Department of Cardiology, Middlemore Hospital, Private Bag 933111, Otahuhu, Auckland, New Zealand; Ruvin Gabriel, Department of Cardiology, Middlemore Hospital, Private Bag 933111, Otahuhu, Auckland, New Zealand.

Acknowledgements

Correspondence

Jen-Li Looi, Department of Cardiology, Middlemore Hospital, Private Bag 93311, Otahuhu, Auckland, New Zealand.

Correspondence Email

JenLi.Looi@middlemore.co.nz

Competing Interests

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

A 61-year-old man, with previous endovascular stenting from distal aortic arch to below the diaphragm for subacute type B aortic dissection in 2010, presented with acute coronary syndrome and subsequently developed intravenous line infection on day 5 of admission. He also described a dull ache in the mid scapular region at the same time while he developed the intravenous line infection. He had ongoing Staphylococcus aureus bacteraemia despite intravenous antibiotics. Transoesophageal echocardiogram showed no vegetations. Contrast CT chest (Panel B and C) demonstrated a soft tissue rind (yellow arrows) around the descending thoracic aorta stent (red arrow) from the level of the 4th thoracic vertebra down to the aortic hiatus, which was new in comparison to the previous scan performed 12 months earlier (Figure A). The appearances were suggestive of an infected endovascular stent with abscess formation. Surgery was not an option, due to multiple medical comorbidities and abscess were unable to be drained percutaneously. He continued to deteriorate and eventually passed away. This report illustrates the diagnostic capability of CT in providing incremental information about the complications associated with prosthetic aortic graft infection for guiding treatment.Learning Points Prosthetic aortic graft infections represent a major diagnostic and therapeutic challenge associated with considerable morbidity and mortality. Computed tomography (CT) is the imaging modality of choice in the investigation of patients with suspected prosthetic aortic graft infection Figure: A: There was no soft tissue thickening around the thoracic stent on the previous scan performed 12 months earlier.Figure B: Contrast CT chest demonstrated a soft tissue rind (yellow arrows) around the descending thoracic aorta stent (red arrow)Figure C: Again, there was soft tissue thickening (yellow arrows) around the descending thoracic aorta stent noted on contrast CT chest on the sagittal plane.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Jen-Li Looi, Department of Cardiology, Middlemore Hospital, Private Bag 933111, Otahuhu, Auckland, New Zealand; Ruvin Gabriel, Department of Cardiology, Middlemore Hospital, Private Bag 933111, Otahuhu, Auckland, New Zealand.

Acknowledgements

Correspondence

Jen-Li Looi, Department of Cardiology, Middlemore Hospital, Private Bag 93311, Otahuhu, Auckland, New Zealand.

Correspondence Email

JenLi.Looi@middlemore.co.nz

Competing Interests

Contact diana@nzma.org.nz
for the PDF of this article

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