- 期刊
Mycotic Aneurysm Manifesting with Life-threatening Hemoptysis-A Case Report and Literature Review
以致命性咳血爲主要症狀之感染性動脈瘤－一個病例報告及文獻回顧
摘要
咳血雖然爲一常見的臨床症狀並且包含種類繁多的鑑別診斷，然而因爲感染性主動脈瘤導致主動脈氣管廔管而咳血的案例卻極爲罕見。本例報告一位七十七歲男性，其症狀爲發燒，咳血，及縱膈腔寬大，其後之影像學檢查指向降主動脈之感染性血管瘤。此病人接受緊急開胸手術，在術中發現一穿孔之降主動脈瘤及周圍肺部之沾黏。此血管瘤及沾黏之肺組織切除並執行植入及重建。病人之痰液及切除組織之細菌培養均長出沙門氏菌D2族群。在抗生素停用半年後之今日，病人狀況穩定無復發感染之跡象。我們願以此案例提醒臨床醫師，在治療咳血及發燒病人的同時，亦應醒覺與此案例類似之可能性，以期相關案例能獲得立即救治及存活之機會。
並列摘要
Although hemoptysis frequently occurs in a broad spectrum of diseases, hemoptysis caused by an aortic mycotic aneurysm with aortobronchial fistula is rare and seldom reported. A 77-year-old man visited our institution with fever, widened mediastinum, and massive hemoptysis; the chest images suggested a descending mycotic aortic aneurysm. An emergent operation revealed a penetrated aneurysm with adhesion to the lung parenchyma; aneurysmal resection and graft reconstruction was performed. Both the resected tissue and sputum culture grew a group D2 Salmonella strain. Six months after discontinuation of antibiotics, the patient was well without evidence of inflammation. This case is a reminder for clinicians to be alert for this rare entity when dealing with a febrile patient with hemoptysis, because the immediate implementation of management may enable the patient to survive.
延伸閱讀
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