© 2005 BMJ Publishing Group Ltd & British Thoracic Society
Images in Thorax
Mycotic aortic aneurysm probably caused by a pleural empyema
Departments of Internal Medicine, Medical Policlinic, Clinical Radiology and Pathology, Ludwig-Maximilians-Universität, Munich, Germany
Correspondence to:
Correspondence to:
Dr H Schmid
Medizinische Poliklinik, Ludwig-Maximilians-Universität München, Pettenkoferstrasse 8a, D-80336 Munich, Germany; holger.schmid@lrz.uni-muenchen.de
| The first 150 words of the full text of this article appear below. |
A 53 year old man was admitted with dyspnoea. A chest radiograph and CT scan suggested bilateral encapsulated pleural empyema (fig 1A and B
). Pleural puncture produced a massive purulent discharge which grew Streptococcus pneumoniae, confirming the diagnosis. The CT scan also showed an enlarged diameter of the thoracic aorta near the diaphragm (4.25 cm; fig 1B). After starting treatment with antibiotics and pleural drainage with flushing, the patient improved rapidly until day 4 when he experienced sudden dyspnoea and had a fatal respiratory and circulatory arrest. Necroscopic examination showed pleurisy but no pneumonia or embolism. At the diaphragmatic level the aorta had two perforations (5x12 and 1x2 mm) with granulocytic infiltrations, proving infection (fig 2).
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Figure 1 (A) Supine chest radiograph on admission. (B) CT scan at thoracic level 11/12 with arterial contrast. Asterisks, empyema fluid; arrow, aortic luminal expansion; l, lung; | |||||||||
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