Mycotic Aneurysm

FACTS

  • typically fusiform, very friable aneurysms
  • most common organisms: streptococcus, staph

HPI


Risk factors
  • HIV / AIDS
  • immunocompromised
  • steroid use
 
Infectious work-up
  • echo
  • BCx
  • CSF Cx (if obtained already)
  • UA / UCx
  • UDS
  • ethanol
  • HIV / Hepatitis

PHYSICAL EXAM

universal exam
  • evaluate dentition
  • evaluate digits (toes, nails, distal ulcers)

IMAGING

  • CTH non-con might show SAH
  • CTA may or may not show an aneurysm
    • may or may not also show emboli / occlusions
A/P
  • ABx are primary traetment
  • Surgery is typically contraindicated unless do not shrink with
  • DSA for diagnosis and monitoring
    • once at time of diagnosis: can identify aneurysms in addition to emboli/occlusions
    • serial monitoring (e.g. 7-10 days, 1.5, 3, 6, 12 months after)
 
A middle aged bacteremic male was found to have L frontal SAH on CTH non-con (left) along with scattered hemorrhages on MRI (middle) including L cerebellar, ultimately only found to have a distal Right PCA mycotic aneurysm (right)
A middle aged bacteremic male was found to have L frontal SAH on CTH non-con (left) along with scattered hemorrhages on MRI (middle) including L cerebellar, ultimately only found to have a distal Right PCA mycotic aneurysm (right)