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(Circulation. 2008;117:1609.)
© 2008 American Heart Association, Inc.

Images in Cardiovascular Medicine

Clostridium Septicum Arch Aortitis

Antonio Laudito, MD; Valerio Gai, MD; Stefania Battista, MD; Domenica Garabello, MD; Giorgio Limerutti, MD; Mauro Rinaldi, MD

From the Divisions of Cardiac Surgery (A.L., M.R.), Emergency Medicine (V.G., S.B.), and Radiology (D.G., G.L.), University of Turin, Turin, Italy.

Correspondence to Dr Antonio Laudito, Division of Cardiac Surgery, University of Turin, Corso Bramante 88–90, 10126 Turin, Italy. E-mail laudito@musc.edu

An extract of the first 100% of the full text is provided, because this article has no abstract.

A 74-year-old diabetic and obese woman presented to emergency department with weakness, chills, and retrosternal pain irradiated to her back. She also reported significant weight loss. Blood tests showed leukocytosis and increased serum fibrinogen. No signs of myocardial ischemia were found. A chest x-ray showed aortic ectasia, and computed tomography imaging of the chest revealed multiple small bubbles of gas infiltrating the aortic arch wall (Figure, A and B). She was hospitalized for suspected aortic arch aortitis, and blood cultures revealed Clostridium septicum infection. Broad-spectrum antibiotic therapy was reassessed according to the antibiogram. A computed tomography scan performed 3 days after the admission showed a decrease in the amount of gas bubbles infiltrating the wall of the aortic arch, with a markedly increased periadventitial inflammatory reaction (Figure, C and D). Colonoscopy revealed an adenocarcinoma of the left colon. While hospitalized, the patient developed a type B aortic dissection with loss of lower limb pulses that was successfully managed with an axillobifemoral bypass surgery. She has been since asymptomatic, with serial blood cultures repeatedly showing no bacteria, and is now scheduled to undergo elective hemicolectomy.

View larger version (54K):   Figure. Computed tomography scans at admission (A and B) and 3 days later (C and D). The arrow shows the aortic arch inflammation with air bubble formation).

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