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Mycotic pseudoaneurysms complicating renal transplantation: a case series and review of literature.

Leonardou P, Gioldasi S, Zavos G, Pappas P - J Med Case Rep (2012)

Bottom Line: Four patients presented with systemic fever and iliac fossa pain and one presented with hemorrhagic shock.Morphologic investigation by color doppler ultrasonography revealed a pseudoaneurysm at the anastomotic site.No recurrence was recorded during the follow-up period.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiology, Laikon General Hospital of Athens, 17 Ag, Thoma str,, 115 27Athens, Greece. pappasparis@hotmail.com.

ABSTRACT

Introduction: Kidney transplantation can be complicated by infection and subsequent development of mycotic aneurysm, endangering the survival of the graft and the patient. Management of this condition in five cases is discussed, accompanied by a review of the relevant literature.

Case presentations: Five patients, three men 42-, 67- and 57-years-old and two women 55- and 21-years-old (mean age of 48 years), all Caucasians, developed a mycotic aneurysm in the region of the anastomosis between renal graft artery and iliac axes. Four patients presented with systemic fever and iliac fossa pain and one presented with hemorrhagic shock. Morphologic investigation by color doppler ultrasonography revealed a pseudoaneurysm at the anastomotic site. A combination of antibiotic therapy, surgery and interventional procedures was required as all kidney transplants had to be removed. No recurrence was recorded during the follow-up period.

Conclusions: A high index of suspicion is required for the timely diagnosis of a mycotic aneurysm; aggressive treatment with cover stents and/or surgical excision is necessary in order to prevent potentially fatal complications.

No MeSH data available.


Related in: MedlinePlus

New covered stent deployment at the orifice of the transplant renal artery (arrows) with sacrifice of the transplanted kidney, which was removed surgically some days later.
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Figure 10: New covered stent deployment at the orifice of the transplant renal artery (arrows) with sacrifice of the transplanted kidney, which was removed surgically some days later.

Mentions: The fifth patient was a 21-year-old Caucasian woman, who had received a renal transplant from a living donor 15 months previously and subsequently developed a mycotic pseudoaneurysm. Apart from iliac fossa pain and fever, there were also signs of abdominal hemorrhage. CDU examination revealed the presence of an aneurysm at the anastomotic region and retroperitoneal blood collection. Blood cultures grew Candida which was treated with intravenous liposomal amphotericin. Percutaneous transluminal treatment was suggested and the pseudoaneurysm was initially packed with coils followed by placement of a covered stent, aiming to keep patent the transplant renal artery (Figures 5, 6, 7, 8). After a short, clinically stable, postoperative period, reappearance of a pseudoaneurysm was recorded (Figure 9); this was treated by insertion of a second covered stent (Figure 10) and renal transplant removal with successful surgical restoration of iliac arteries. Antifungal therapy with oral fluconazole had been continued for two months.


Mycotic pseudoaneurysms complicating renal transplantation: a case series and review of literature.

Leonardou P, Gioldasi S, Zavos G, Pappas P - J Med Case Rep (2012)

New covered stent deployment at the orifice of the transplant renal artery (arrows) with sacrifice of the transplanted kidney, which was removed surgically some days later.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3295713&req=5

Figure 10: New covered stent deployment at the orifice of the transplant renal artery (arrows) with sacrifice of the transplanted kidney, which was removed surgically some days later.
Mentions: The fifth patient was a 21-year-old Caucasian woman, who had received a renal transplant from a living donor 15 months previously and subsequently developed a mycotic pseudoaneurysm. Apart from iliac fossa pain and fever, there were also signs of abdominal hemorrhage. CDU examination revealed the presence of an aneurysm at the anastomotic region and retroperitoneal blood collection. Blood cultures grew Candida which was treated with intravenous liposomal amphotericin. Percutaneous transluminal treatment was suggested and the pseudoaneurysm was initially packed with coils followed by placement of a covered stent, aiming to keep patent the transplant renal artery (Figures 5, 6, 7, 8). After a short, clinically stable, postoperative period, reappearance of a pseudoaneurysm was recorded (Figure 9); this was treated by insertion of a second covered stent (Figure 10) and renal transplant removal with successful surgical restoration of iliac arteries. Antifungal therapy with oral fluconazole had been continued for two months.

Bottom Line: Four patients presented with systemic fever and iliac fossa pain and one presented with hemorrhagic shock.Morphologic investigation by color doppler ultrasonography revealed a pseudoaneurysm at the anastomotic site.No recurrence was recorded during the follow-up period.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiology, Laikon General Hospital of Athens, 17 Ag, Thoma str,, 115 27Athens, Greece. pappasparis@hotmail.com.

ABSTRACT

Introduction: Kidney transplantation can be complicated by infection and subsequent development of mycotic aneurysm, endangering the survival of the graft and the patient. Management of this condition in five cases is discussed, accompanied by a review of the relevant literature.

Case presentations: Five patients, three men 42-, 67- and 57-years-old and two women 55- and 21-years-old (mean age of 48 years), all Caucasians, developed a mycotic aneurysm in the region of the anastomosis between renal graft artery and iliac axes. Four patients presented with systemic fever and iliac fossa pain and one presented with hemorrhagic shock. Morphologic investigation by color doppler ultrasonography revealed a pseudoaneurysm at the anastomotic site. A combination of antibiotic therapy, surgery and interventional procedures was required as all kidney transplants had to be removed. No recurrence was recorded during the follow-up period.

Conclusions: A high index of suspicion is required for the timely diagnosis of a mycotic aneurysm; aggressive treatment with cover stents and/or surgical excision is necessary in order to prevent potentially fatal complications.

No MeSH data available.


Related in: MedlinePlus