title: Successful treatment of a mycotic pseudoaneurysm of the brachial artery with percutaneous ultrasound-guided thrombin injection and antibiotics.
abstract: We report the case of a 48 year old male with human immuno-deficiency virus and hepatitis C virus infection and previous grafting of a thoracic aortic aneurysm. He returned from a trip to India with fever and in a poor physical condition. Diagnostic work-up revealed septicaemia with staphylococcus aureus, infection of the aortic graft with covered rupture of the proximal anastomosis and mitral valve endocarditis. Following antibiotic therapy, implantation of a transcutaneous endovascular aortic prosthesis and mitral valve repair were performed. During the postoperative period, the patient complained of pain and a palpable pulsating mass in the right cubital fossa. Ultrasound scan revealed a pseudoaneurysm at the brachial artery bifurcation. Since there were no signs of venous puncture in this area, we assumed this to be a mycotic pseudoaneurysm resulting from septic embolism. In the absence of clinical signs of inflammation, this pseudoaneurysm was successfully treated by ultrasound-guided thrombin injection. Irrespective of the cause for this mycotic pseudoaneurysm of the brachial artery, percutaneous ultrasound-guided thrombin closure in combination with antibiotic therapy might be a feasible, safe, cheap and minimally-invasive alternative to surgery.
authors.affiliation: Swiss Cardiovascular Center, Division of Clinical and Interventional Angiology, Inselspital, University Hospital Bern, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Poloczek
authors.forename: B
authors.initials: B
authors.lastname: Amann-Vesti
authors.forename: C
authors.initials: C
authors.lastname: Thalhammer
authors.forename: T
authors.initials: T
authors.lastname: Meier
authors.forename: M
authors.initials: M
authors.lastname: Husmann
mesh_terms: D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000382:microbiology; D000785:Aneurysm, Infected / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000382:microbiology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001916:Brachial Artery / Q000000981:diagnostic imaging* / Q000382:microbiology; D004359:Drug Therapy, Combination; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D013917:Thrombin / Q000008:administration & dosage*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D000900:Anti-Bacterial Agents; D013917:Thrombin