Clostridium Septicum Arch Aortitis
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.