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Mycotic

Aneurysm KAMAL

MOJAB,1

LEONARDO

T.

Mycotic

aneurysm of jaundice

bacterial due to

endocarditis. this lesion

describe

a case

in

a

the

artery

right

the

Hepatic

complication structive hepatic

of

of the

hepatic

which

ruptured,

branch

is

LIM,2

a

aneurysm

a pseudoaneurysm which

caused

line

of

obstructive

phosphatase

calf

3

weeks

earlier

followed

by

swelling

insufficiency,

aontic

valve

vegetations,

Fig. formation

1.-Early

(A).

middle

of pseudoaneurysm

disclosed

vein. The

and

Received July 8, 1976; accepted 1 Department of Radiology, Cook 2

Am

Department

J Roentgenol

of Surgery.

Cook

128:143-144,

anterointerior

(C) of selective

January

an-

Hospital,

1977

hepatic

and of

A

small

bengal

in the

and

left

ponta

night

was findings

hepatis

demonstrated hepatic

seen

Chicago,

at

were

techand

an

aneurysmal

arteries,

the

hilus

confirmed

The patient’s postoperative course was obstructive jaundice was completely resolved.

angiogram

28. 1976. West Harrison, Illinois

showed and

lobe.

the right antenoinfenion and upward displacement

aneurysm

scan

jaundice,

angiography

right

angiographic

Rose

prominent

uptake

splenic the

lU. obstructive

with

a large

branch (fig. 1) of the portal of 12

the

spleen.

days

showing

aneurysmal

dilation

of right

uneventful;

and left hepatic

branch.

after revision September County Hospital, 1835 County

an

PORTELA’

later

when the patient underwent surgery. A diffuse mycotic aneurysm of the night and left hepatic arteries and the right anteroinfenior branch had ruptured into the liven substance, forming a large pseudoaneurysm that compressed the intrahepatic biliary ducts and obliterated the cystic duct. The gallbladder was significantly distended and inflamed. Surgical procedures included hepatic, artery ligation after a test period of temporary occlusion, evacuation of the pseudoaneurysm, cholecystectomy, and drainage.

to treatment, and during abdominal pain and pro-

(B). and late phase of right

and

Jaundice

LUIZ

1,606

netium liver scan area of decreased

pseudoaneurysm of causing compression

tenderness. On physical examination a low-grade systolic murmur was heard at the apex in the left fifth intercostal space. Numerous hemorrhagic spots were found in the skin, the conjunctivas, and the fundus of the right eye. Cenebrospinal fluid, urine, and blood cultures grew coagulasepositive Staphylococcus aureus, and therapy was started with oxacillin. Echocandiognaphy and cardioangiography revealed eurysm of the left ventricle. The patient did not respond well the seventh week of hospitalization

was

with

Hepatic

right

AND

compatible

dilatation

Case Report A 17-year-old nonaddicted black male was admitted to Cook County Hospital because of muscular tenderness, fever, and progressive lethargy. There had been blunt trauma to

mitral

ESFAHANI,1

findings

the

jaundice.

his

Obstructive

gressive jaundice developed. Total and direct serum bilirubin levels were 8.2/100 ml and 5.1/100 ml, respectively; alka-

obWe

of

Causing

FRAYDOON

known

However, is rare [1].

mycotic

forming

anteroinfenior

artery

Artery

Chicago.

60612.

143

Illinois

60612.

Address

reprint

requests

to K. Mojab.

arteries

the

with

CASE

144

REPORTS

ACKNOWLEDGM

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Discussion About artery

80% are

seldom

of

extrahepatic

made,

liver.

Angiography it

is

aneurysms [2].

especially

since vascular

mycotic

the

is most

may

settling vasa cause

ectasia,

on

diagnosis

lesion

essential

in

accurate

method

the

vasorum

all

is for

is

within

suspected

trauma,

surface

Although

lesions,

Predisposing

endocarditis,

by infected or the vasa

inner

[3].

vascular

responsible. tonal

the

hepatic

S. factors

atherosclerosis, and

gallbladder

of

aureus are

vessel most

septicemia,

disease.

lodging or by on

organisms

hereditary

Talge

and

ENTS Jeffrey

Green

for

technical

assistance.

cases,

the is

George

diagnosing

emboli vasorum,

various

thank

the

lesions.

bacteria the

the

Preoperative if

These lesions are formed in the lumen of the vessels in

of

We

often bactelangi-

REFERENCES 1 . Stack BHR, Rankin JT, Bentley RJ: Hepatic artery aneurysm after staphylococcal endocarditis. Br Med J 3: 659-660, 1968 2. Weaver DH, Fleming RJ, Barnes WA: Aneurysm of the hepatic artery: the value of arteniography in surgical management. Surgery 64:891-896, 1968 3. Nakata Y, Shionoya S. Kamiya K: Pathogenesis of mycotic aneurysm. Angiology 19:593-601 , 1968