Pseudomonas aeruginosa causing a right carotid artery mycotic aneurysm after a dental extraction procedure
Pseudomonas aeruginosa causing a right carotid artery mycotic aneurysm after a dental extraction procedure
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DOI：
10.4065/77.10.1125
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发表时间：
2002-10-01
影响因子：
8.9
通讯作者：
Celani, VJ
中科院分区：
文献类型：
--
作者：
Knouse, MC;Madeira, RG;Celani, VJ
颈动脉的真菌性动脉瘤是罕见的。我们描述一个右颈动脉真菌性动脉瘤在一个70岁的男子。他的症状在复杂的磨牙拔牙后立即出现，并一直持续到确诊并进行手术切除和修复。铜绿假单胞菌从多个血培养和切除组织中分离。我们回顾了通过广泛的文献检索发现的另外73例病例。菌血症、近期手术、头颈部感染、牙齿感染和心内膜炎是最常见的易感条件。计算机断层扫描和磁共振成像技术可以准确地确认任何动脉瘤的怀疑，但血管造影术是金标准。首选的治疗策略是动脉瘤原发切除和静脉介入，并配合长期的抗生素治疗。到目前为止，包括我们的病例在内，共有6例病例与牙科外科手术明显相关。这些病例的特点是发热时颈部肿块迅速增大。微生物，特别是革兰氏阴性杆状菌，与正常的口腔菌群相反，如链球菌和厌氧菌，经常被分离出来。及时诊断和治疗，结果往往令人满意。
Mycotic aneurysms of the carotid arteries are rare. We describe a right carotid artery mycotic aneurysm in a 70-year-old man. His symptoms began immediately after a complicated molar extraction and persisted until the diagnosis was made and surgical resection and repair were undertaken. Pseudomonas aeruginosa was isolated from multiple blood cultures and excised tissues. We review another 73 cases uncovered by an extensive literature search. Bacteremia, recent surgery, head and neck infections, dental infections, and endocarditis are the most common predisposing conditions. Computed tomography and magnetic resonance imaging are techniques for accurately confirming the suspicion of any aneurysm, but angiography is the gold standard. Primary resection of the aneurysm with native vein interposition, in conjunction with prolonged antibiotic therapy, is the preferred strategy. A total of 6 cases thus far, including ours, have been clearly associated with dental surgical procedures. These cases are characterized by rapidly enlarging neck masses in the presence of fever. Microorganisms, particularly gram-negative rods, in contrast to normal oral flora, eg, streptococci and anaerobes, are often isolated. With prompt diagnosis and treatment, outcome is often satisfactory.