Computed tomography in the evaluation of the patient with symptomatic abdominal aortic aneurysm

Infectious abdominal aortic aneurysms often present with abdominal and lower back pain, but prolonged fever may be the only symptom. Infectious abdominal aortic aneurysms initially presenting with meningitis are extremely rare; there are no reports of their successful treatment. Cases withStreptococcus pneumoniaeas the causative bacteria are even rarer with a higher mortality rate than those caused by other bacteria. We present the case of a 65-year-old man with lower limb weakness and back pain. Examination revealed fever and neck stiffness. Cerebrospinal fluid showed leukocytosis and low glucose levels. The patient was diagnosed with meningitis and bacteremia caused byStreptococcus pneumoniaeand treated with antibiotics. Fever, inflammatory response, and neurologic findings showed improvement. However, abdominal computed tomography revealed an aneurysm not present on admission. Antibiotics were continued, and a rifampicin soaked artificial vascular graft was implanted. Tissue cultures showed no bacteria, and histological findings indicated inflammation with high leukocyte levels. There were no postoperative complications or neurologic abnormalities. Physical examination, blood tests, and computed tomography confirmed there was no relapse over the following 13 months. This is the first reported case of survival of a patient with an infectious abdominal aortic aneurysm initially presenting with meningitis caused byStreptococcus pneumoniae.

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Faculty Opinions recommendation of The Incidence of Para-Anastomotic Aneurysm After Open Repair Surgery for Abdominal Aortic Aneurysm Through Routine Annual Computed Tomography Imaging.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.739590210.793583206 ◽

2021 ◽

Author(s):

Norman Hertzer

Keyword(s):

Computed Tomography ◽

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Open Repair ◽

Computed Tomography Imaging ◽

Tomography Imaging ◽

Anastomotic Aneurysm ◽

Abdominal Aortic

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Maximum Diameter of Native Abdominal Aortic Aneurysm Measured by Angio-Computed Tomography

Aorta ◽

10.12945/j.aorta.2015.14-059 ◽

2015 ◽

Vol 03 (02) ◽

pp. 47-55 ◽

Cited By ~ 6

Author(s):

Caroline Mora ◽

Claude Marcus ◽

Coralie Barbe ◽

Fiona Ecarnot ◽

Anne Long

Keyword(s):

Computed Tomography ◽

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Weighted Kappa ◽

Maximum Diameter ◽

Clinical Decisions ◽

Diameter Measurement ◽

Double Blind ◽

Automated Method ◽

Abdominal Aortic

Background: Computed tomography angiography (CTA) is the reference technique for the measurement of native maximum abdominal aortic aneurysm (AAA) diameter when surgery is being considered. However, there is a wide choice available for the methodology of maximum AAA diameter measurement on CTA, and to date, no consensus has been reached on which method is best. We analyzed clinical decisions based on these various measures of native maximum AAA diameter with CTA, then analyzed their reproducibility and identified the method of measurement yielding the highest agreement in terms of patient management. Materials and Methods: Three sets of measures in 46 native AAA were obtained, double-blind by three radiologists (J, S, V) on orthogonal planes, curved multiplanar reconstructions, and semi-automated-software, based on the AAA-lumen centerline. From each set, the clinical decision was recorded as follows: "Follow-up" (if all diameters <50 mm), "ambiguous" (if at least one diameter <50 mm AND at least one ≥50 mm) or "Surgery " (if all diameters ≥50 mm). Intra- and interobserver agreements in clinical decisions were compared using the weighted Kappa coefficient. Results: Clinical decisions varied according to the measurement sets used by each observer, and according to intra and interobserver (lecture#1) reproducibility. Based on the first reading of each observer, the number of AAA proposed for surgery ranged from 11 to 24 for J, 5 to 20 for S, and 15 to 23 for V. The rate of AAAs classified as "ambiguous" varied from 11% (5/46) to 37% (17/46).The semi-automated method yielded very good intraand interobserver agreements in clinical decisions in all comparisons (Kappa range 0.83–1.00). Conclusion: The semi-automated method seems to be appropriate for native AAA maximum diameter measurement on CTA. In the absence of AAA outer-wallbased software more robust for complex AAA, clinical decisions might best be made with diameter values obtained using this technique.

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