Infected Aneurysm of the Superficial Femoral Artery: A Case Report

感染性表淺股動脈瘤－病例報告

連守揚(Shoou-Yang Lian) ； 周治剛(Chih-Kang Chou) ； 林伯彥(Po-Yen Lin) ； 姚仲勉(Geoffery Yeo) ； 葉明煌(Ming-Huang Yeh) ； 李天植(Tian-Che Lee) ； 董宏一(Hung-Yi Dung)

《Journal of Emergency Medicine, Taiwan》 8卷4期 (2006/12) Pp. 142-146

摘要

感染性動脈瘤是一種不常見，但卻有高死亡率的疾病。最常見的原因是：動脈創傷及心內膜炎，最常見感染性動脈瘤的動脈是：股動脈及腹主動脈。早期診斷感染性動脈瘤仍舊是急診醫師的挑戰。我們報告一位長期服用類固醇控制風溼性關節炎的病患，因右大腿腫痛送至本院急診就醫。該病人全血球計數顯示白血球過多，右大腿X光顯示產氣性肌肉壞死，電腦斷層顯示沿著股內收肌有體液及空氣聚集，於緊急手術中發現感染性動脈瘤破裂，並且於病人的血液培養出沙門氏菌。為了病患最好的預後，急診醫師必須有高度的懷疑、早期適當的放射線評估、積極廣效性的抗生素使用、以及儘早外科照會。

關鍵字

感染性動脈瘤 ； 動脈創傷 ； 心內膜炎 ； 沙門氏菌

並列摘要

Infected aneurysms are uncommon and have a high mortality. The two most common etiologies are arterial trauma and endocarditis. The most commonly affected artery is the femoral artery, followed by the abdominal aorta. Early diagnosis continues to be a challenge for emergency physicians. We report on a patient with rheumatoid arthritis under long-term steroid control who suffered from pain and swelling in the right thigh. Because of rapid development of pain and swelling, he was sent to our emergency department. The complete blood count revealed leukocytosis. Radiographs of the right thigh revealed diffuse gas forming myonecrosis. Computed tomography revealed fluid collection and air pockets along the deep fascia of the adductor muscles. Rupture of an infected aneurysm was noted during emergency surgery. Blood cultures were positive for Salmonella enteritidis group B. Emergency physicians must have a high index of suspicion of this condition, and early appropriate radiological evaluation, aggressive antibiotic usage and prompt surgical consultation are needed to obtain the best outcome.

並列關鍵字

infected aneurysm ； arterial trauma ； endocarditis ； salmonella