CARDIOVASCULAR JOURNAL OF AFRICA • Vol 22, No 3, May/June 2011
AFRICA
143
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Mycotic pseudoaneurysm of the ascending aorta
following purulent pericardial effusion diagnosed
by multi-slice computed tomography
B ERKUT, N BECIT, M KANTARCI, N CEVIZ
Abstract
Mycotic pseudoaneurysm of the aorta is an uncommon
disease, especially in childhood but has a high mortality due
to spontaneous rupture. It is caused by endarteritis follow-
ing bacteraemia or fungaemia. Due to spontaneous rupture,
early diagnosis is very important.
Keywords:
ascending aortic pseudoaneurysm, purulent pericar-
ditis, surgery treatment
Submitted 10/11/09, accepted 29/3/10
Cardiovasc J Afr
2011;
22
: 143–144
DOI: CVJ-21.023
Case report
An eight-year-old girl was admitted to our hospital with
complaints of fever, weakness, sore throat, shortness of breath
and lack of appetite over the previous 10 days. She had no history
of mediastinal surgery or recent trauma. She had a temperature
of 39°C, arterial blood pressure of 70/30 mmHg, pulse rate of
140 beats/min and respiratory rate of 50 breaths/min.
Echocardiography revealed cardiac tamponade, and she
required pericardial surgical drainage. A chest tube was inserted
as an emergency into the pericardial cavity via a subxiphoid
incision and 350 ml of viscous fluid with exudate was evacuated.
Parenteral amikacin and teicoplanin were initiated for antibacte-
rial treatment. Gram stains of the pericardial fluid revealed gram-
positive cocci, which were then identified as a staphilococcus
species. The pericardial drain was removed on the third day.
Control echocardiography was then carried out to check for
pericardial effusion. There was minimal fluid in the pericardial
cavity, but a mass was detected on the lateral site of the ascend-
ing aorta. Multi-slice computed tomography (MSCT) showed a
4
×
5-cm mass between the superior vena cava and the ascend-
ing aorta (Fig. 1A). Contrast-enhanced axial MSCT (Fig. 1B)
and coronal reconstruction image (Fig. 1C) revealed a mass
measuring 41
×
55
×
42 mm, which was diagnosed as a pseu-
doaneurysm.
After inserting a pericardial tube, a chest X-ray was done and
we realised that the tube went through the pulmonary artery, not
Department of Cardiovascular Surgery, Erzurum Training
and Research Hospital, Erzurum, Turkey
BILGEHAN ERKUT, MD,
Department of Cardiovascular Surgery, Atatürk University
Medical Faculty, Erzurum, Turkey
NECIP BECIT, MD
Department of Radiology, Atatürk University Medical
Faculty, Erzurum, Turkey
MECIT KANTARCI, MD
Department of Pediatric Cardiology, Atatürk University
Medical Faculty, Erzurum, Turkey
NACI CEVIZ, MD
