title: Proteus Mediastinitis Causing Fatal Pseudoaneurysm following Aortic Valve Replacement.
abstract: We report an unusual case of Gram-negative mediastinitis following aortic valve replacement via median sternotomy. The patient presented two months after surgery following a urinary tract infection in septic shock with a discharging sternal wound and blood cultures positive for Proteus mirabilis. Imaging revealed a large anterior mediastinal abscess and aortic pseudoaneurysm which subsequently ruptured resulting in fatality. Gram-negative mediastinitis is a rare complication of cardiac surgery that can present late following initial clinical improvement and should be considered when "remote site" infections are present. Computerised Tomography scanning has a role to play in the identification of this.
authors.affiliation: Department of Radiology, Horton General Hospital, Oxford University Hospitals NHS Trust, Oxford Road, Banbury, Oxfordshire OX16 9AL, UK.
authors.forename: Sarfraz
authors.initials: S
authors.lastname: Nazir
authors.affiliation: Department of Surgery, Horton General Hospital, Oxford University Hospitals NHS Trust, Oxford Road, Banbury, Oxfordshire OX16 9AL, UK.
authors.forename: John
authors.initials: J
authors.lastname: Jeffery
authors.affiliation: Department of Surgery, Horton General Hospital, Oxford University Hospitals NHS Trust, Oxford Road, Banbury, Oxfordshire OX16 9AL, UK.
authors.forename: Alexandra-Alice
authors.initials: AA
authors.lastname: Tenovici
authors.affiliation: Department of Radiology, Horton General Hospital, Oxford University Hospitals NHS Trust, Oxford Road, Banbury, Oxfordshire OX16 9AL, UK.
authors.forename: Horace
authors.initials: H
authors.lastname: D'Costa