Early Radiographic Detection of Ruptured Mycotic Aneurysm Adjacent with Salmonella Spondylitis: Clinical Examples and Literature Review

Objective: Organisms of Salmonella are the most common pathogens in spondylitis coexisting with adjacent mycotic aneurysm. The primary site may be the spine or aorta, then directly extend to the contiguous structures. The diagnosis and treatment of concurrent lesions is more difficult. Our goal is to present imaging features and management of this entity together with a literature review. Patients and methods: The author reviewed two patients of Salmonella spondylitis with concurrent ruptured aortic aneurysm who presents with only back pain and fever. The patient with T12-L1 spondylitis had two aneurysms: the ruptured one with pseudoaneurysm formation was adhere to T12-L1 spondylitis and another one was in front of the L5 vertebra and not continuous with the spondylitis. Another patient had an infected ruptured aortic aneurysm at L3-4, with only minimal bone destruction. Gallium scan and contrast-enhanced CT are useful in early radiographic detection of ruptured mycotic aortic aneurysm. They both received urgent radical resection of the aneurysm and with or without bony stabilization. In both, the primary site of infection appears to have been the aorta. Both patients had satisfactory functional results. Conclusions: Early surgical intervention of concurrent aneurysm is the keystone of clinical success and a surgical procedure at the site of an unsuspected aneurysm may precipitate life-threatening hemorrhage. Both the spinal surgeon and radiologist must be aware of this condition and with a high index of suspicion.

並列關鍵字

Salmonella spondylitis ； mycotic aneurysm ； gallium scan ； contrast-enhanced CT

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