A rare case with mycotic abdominal aortic pseudoaneurysm due to Salmonella Infection is described. A 75 year-old female had been diagnosed as an abdominal aortic aneurysm by ultrasonics at the other hospital during the examination of fever of unknown origin and abdominal pain. At admission to our hospital, the temperature was 39.5°C. A pulsatile mass, about the size of five cm in diameter, was present with no inflammatory findings in the abdomen. Ultrasonics and angiography revealed a saccular infrarenal aortic aneurysm. The blood culture was positive for Salmonella choleraesuis. Aneurysmectomy and graft interposition were performed five weeks after admission, because of enlargement of the size of aneurysm and the continuing infective signs in spite of antibacterial therapy. The patient narrowly escaped from rupture of the pseudoaneurysm by the body of third lumber vertebra. On microscopic examination, infective findings were seen in the wall of pseudoaneurysm. After treatment with antibiotics for four weeks, the patient was discharged from the hospital. She remains asymptomatic for a year after the operation. Only eight cases of mycotic abdominal aortic aneurysm have been reported previously in Japan, and five cases, including our case, were due to Salmonella infection. The results of this surgical operations, carefully considered for infection, were good, but it seems better to select alternatively the surgical operation as soon as possible when antibacterial therapy is not effective.

A 44-year-old woman in whom multiple descending aortic aneurysms with pseudocoarctation was diagnosed underwent graft replacement. The aneurysms consisted of two large and one small aneurysms. One of the large aneurysms was a fusiform type aneurysm (38mm in diameter), and another one was a saccular type aneurysm (53mm in diameter). There was a small saccular type aneurysm (12mm in diameter) the site of the at stenotic lesion, and the wall of the small aneurysm was very thin. Atherosclerotic changes were not found inside the aneurysmal wall. Aneurysm occurring at the proximal side of the stenotic lesions of pseudocoarctation are rare, and only four cases have been reported in Japan.

We report a case of rupture of the thoracic descending aorta due to blunt chest trauma. An 18-year-old man was transferred to our hospital after a car accident. He was in a state of shock. The admission chest X-ray film demonstrated mediastinal widening and blurring of the aortic arch. Chest and abdominal helical CT scan showed left hemothorax, pseudoaneurysm, and hematoma of the cervix, mediastinum, and retroperitoneal space. We diagnosed rupture of the thoracic descending aorta without other injuries. An emergency operation was performed under partial cardiopulmonary bypass with systemic heparinization. The descending aorta had completely lost its continuity. Graft replacement was performed with a collagen-sealed woven Dacron graft. The postoperative course was uneventful. We suggest that high awareness and a systematic approach are needed to diagnose traumatic aortic rupture, and that enhanced helical CT scanning is helpful for diagnosis and management strategy.

A 72-year-old woman complaining of lumbago was transferred to our hospital in a state of shock. An admission abdominal CT scan showed infrarenal aortic aneurysm reaching 8cm in maximal diameter and hematoma of the retroperitoneal space. A clinical diagnosis of ruptured abdominal aortic aneurysm was rapidly established. An emergency operation was performed under general anesthesia. Laparotomy disclosed an infrarenal abdominal aortic aneurysm and hematoma. The aorta was clamped just below the bilateral renal arteries. Straight graft replacement was performed. There was enough heparinization during the surgical procedure. Postoperative findings involved paraplegia and hypoesthesia from dermatome Th 10 with associated urinary and fecal incontinence. The patient was discharged from our hospital. Spinal cord ischemia is a rare and unpredictable complication in surgery of infrarenal abdominal aortic aneurysms. Presence of intra- and postoperative episodes of hypotension and the duration of the crossclamping seem to have been the most important factors for spinal cord ischemia in this case.