Carlos S Restrepo1, Tomas V Gonzalez2, Ameya Baxi3, Carlos A Rojas4. 1. The University of Texas Health San Antonio, 7703 Floyd Curl Drive, Mail Code 7800, San Antonio, TX, 78229-3900, USA. Electronic address: restrepoc@uthscsa.edu. 2. The University of Texas Health San Antonio, 7703 Floyd Curl Drive, Mail Code 7800, San Antonio, TX, 78229-3900, USA. Electronic address: gonzaleztv@livemail.uthscsa.edu. 3. The University of Texas Health San Antonio, 7703 Floyd Curl Drive, Mail Code 7800, San Antonio, TX, 78229-3900, USA. Electronic address: baxi@uthscsa.edu. 4. Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA. Electronic address: rojas.carlos@mayo.edu.
Abstract
BACKGROUND: Infected coronary artery aneurysms (ICAA) represent a rare but potentially fatal complication of pre-existent atherosclerotic or non-atherosclerotic coronary artery disease, percutaneous coronary artery intervention, endocarditis or extracardiac infection. METHODS: A retrospective analysis of four cases in addition to 51 infected coronary artery aneurysms from the literature, for a total of 55 ICAA was performed. Clinical and morphological information including age, sex, clinical presentation, microbial cultures, size, location and associated abnormalities as well as patient outcome was reviewed. RESULTS: 83% of affected patients were adult males, with an average age of 55.24 years. The right coronary artery was the most commonly affected vessel (40%). In nearly 80% of the time, the responsible organism was either Staphylococcus aureus (53.3%), or Streptococcus (20%) infection. ICAA are typically large, on average 3.4 cm in diameter and can measure up to 9 cm. On contrast enhanced CT, imaging features include lobulated contour or saccular shape (54.2%) with thick wall or mural thrombus (87.5%). Associated abnormal appearance of the pericardium with either pericardial fluid, thickening or loculation is common (79.2%). CONCLUSION: ICAA are typically large, and characterized by a thick wall with a lobulated or saccular shape. Association with mediastinal, chest wall or pericardial abnormalities are common. This combination of findings, in the setting of fever, known infection, or recent coronary intervention should raise concern for ICAA.
BACKGROUND:Infected coronary artery aneurysms (ICAA) represent a rare but potentially fatal complication of pre-existent atherosclerotic or non-atherosclerotic coronary artery disease, percutaneous coronary artery intervention, endocarditis or extracardiac infection. METHODS: A retrospective analysis of four cases in addition to 51 infected coronary artery aneurysms from the literature, for a total of 55 ICAA was performed. Clinical and morphological information including age, sex, clinical presentation, microbial cultures, size, location and associated abnormalities as well as patient outcome was reviewed. RESULTS: 83% of affected patients were adult males, with an average age of 55.24 years. The right coronary artery was the most commonly affected vessel (40%). In nearly 80% of the time, the responsible organism was either Staphylococcus aureus (53.3%), or Streptococcus (20%) infection. ICAA are typically large, on average 3.4 cm in diameter and can measure up to 9 cm. On contrast enhanced CT, imaging features include lobulated contour or saccular shape (54.2%) with thick wall or mural thrombus (87.5%). Associated abnormal appearance of the pericardium with either pericardial fluid, thickening or loculation is common (79.2%). CONCLUSION:ICAA are typically large, and characterized by a thick wall with a lobulated or saccular shape. Association with mediastinal, chest wall or pericardial abnormalities are common. This combination of findings, in the setting of fever, known infection, or recent coronary intervention should raise concern for ICAA.
Authors: Luca Esposito; Marco Di Maio; Angelo Silverio; Francesco Paolo Cancro; Michele Bellino; Tiziana Attisano; Fabio Felice Tarantino; Giovanni Esposito; Carmine Vecchione; Gennaro Galasso; Cesare Baldi Journal: Front Cardiovasc Med Date: 2022-02-04