Emphysematous Salmonella aortitis with mycotic aneurysm.

Montrivade S, et al. BMJ Case Rep 2017. doi:10.1136/bcr-2017-220520 DESCRIPTION A 53-year-old man with history of poorly controlled diabetes mellitus presented with left chest pain radiated to the left shoulder for 3 weeks. On examination, he had low-grade fever, tachypnoea, regular pulse rate at 90/min and blood pressure 140/90 mm Hg. His cardiovascular and chest examinations were otherwise unremarkable. Initial blood test showed leucocytosis and elevated C reactive protein level. Chest radiograph revealed abnormal soft tissue density silhouette with proximal descending aorta with air-filled collection (figure 1, arrow). Contrast-enhanced CT of the aorta (CTA) revealed 1.3×1.5 cm outpouching lesion protruded from the anterior aspect of the proximal descending thoracic aorta (figure 2A, asterisks) with periaortic collection containing multiple air pockets (figure 2A, arrows) surrounding the aortic arch. Salmonella group D bacteraemia was confirmed with consecutive blood cultures. He was diagnosed with Salmonella aortitis complicated with mycotic aneurysm and periaortic abscess. A high-dose intravenous ceftriaxone was started. He subsequently underwent endovascular aortic graft implantation with carotid–left subclavian bypass graft. After 6 weeks of intravenous antibiotic, the pain and fever subsided gradually and follow-up CTA showed substantial decrease in the size of periaortic abscess (figure 2B). Non-typhoidal Salmonella serovars are a leading cause of Gram-negative bacterial aortitis and Emphysematous Salmonella aortitis with mycotic aneurysm Sakolwat Montrivade, Chanapong Kittayarak, Gompol Suwanpimolkul, Pairoj Chattranukulchai Images in...