title: Vegetation attached to the elephant trunk.
abstract: The elephant trunk technique is used as a standard method in the approach to staged repair of extensive thoracic aneurysms. Here, we present a rare case of a graft infection, in which vegetation was attached to the distal end of the elephant trunk. A 36-year old male who had undergone total arch replacement with elephant trunk installation for type A aortic dissection was readmitted for high-grade fever. At the time of admission, Osler's nodules were present and brain magnetic resonance imaging showed multiple small emboli and haemorrhages. Transoesophageal echocardiography could not locate any sign of infection within the cardiac chambers, but disclosed vegetation attached to the elephant trunk. He underwent successful emergent graft replacement of the lesion, and no recurrence of the infection has been observed.
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. akikotanaka623@gmail.com
authors.forename: Akiko
authors.initials: A
authors.lastname: Tanaka
authors.forename: Toshihito
authors.initials: T
authors.lastname: Sakamoto
authors.forename: Kenji
authors.initials: K
authors.lastname: Okada
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Okita
mesh_terms: D000328:Adult; D000784:Aortic Dissection / Q000601:surgery; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001011:Aorta / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery; D001807:Blood Vessel Prosthesis / Q000382:microbiology*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D017548:Echocardiography, Transesophageal; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000601:surgery; D013211:Staphylococcus aureus / Q000302:isolation & purification; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin
keywords: Aortic dissection; Elephant trunk technique; Transoesophageal echocardiography; Vegetation