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Internal carotid artery blister-like aneurysm caused by Aspergillus - case report.

Ogawa M, Sakurai K, Kawaguchi T, Naiki-Ito A, Nakagawa M, Okita K, Matsukawa N, Shibamoto Y - Pol J Radiol (2015)

Bottom Line: An 83-year-old man received corticosteroid pulse therapy followed by oral steroid therapy for an inflammatory pseudotumor of the clivus.Two months later, the patient was transported to an emergency department due to the diffuse subarachnoid hemorrhage, classified as Fisher group 4.Notably, that change was present more densely in the inner membrane than in the outer one.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.

ABSTRACT

Background: Blister-like aneurysm of the supraclinoid internal carotid artery (ICA) is a well-documented cause of subarachnoid hemorrhage. Generally, this type of aneurysm is associated with various conditions such as hypertension, arteriosclerosis, and ICA dissection. Although Aspergillus is the most common organism causing intracranial fungal aneurysmal formation, there is no report of a blister-like aneurysm caused by Aspergillus infection.

Case report: An 83-year-old man received corticosteroid pulse therapy followed by oral steroid therapy for an inflammatory pseudotumor of the clivus. Two months later, the patient was transported to an emergency department due to the diffuse subarachnoid hemorrhage, classified as Fisher group 4. Subsequent 3D computed tomography angiogram revealed a blister-like aneurysm at the superior wall of the left ICA. Six days later, the patient died of subarachnoid hemorrhage caused by the left ICA aneurysm rerupture. Autopsy revealed proliferation of Aspergillus hyphae in the wall of the aneurysm. Notably, that change was present more densely in the inner membrane than in the outer one. Thus, it was considered that Aspergillus hyphae caused infectious aneurysm formation in the left ICA via hematogenous seeding rather than direct invasion.

Conclusions: The blister-like aneurysm is a rare but important cause of subarachnoid hemorrhage. This case report documents another cause of blister-like aneurysms, that is an infectious aneurysm associated with Aspergillus infection.

No MeSH data available.


Related in: MedlinePlus

Hematoxylin and eosin stain revealed destruction of the elastica interna and media, and numerous infiltrating inflammatory cells in the aneurysmal wall. Destruction of the wall structures was more severe in the inner membrane than in the outer one. Grocott’s stain revealed Aspergillus hyphae in the inflamed areas of the arterial wall (inset).
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f4-poljradiol-80-159: Hematoxylin and eosin stain revealed destruction of the elastica interna and media, and numerous infiltrating inflammatory cells in the aneurysmal wall. Destruction of the wall structures was more severe in the inner membrane than in the outer one. Grocott’s stain revealed Aspergillus hyphae in the inflamed areas of the arterial wall (inset).

Mentions: The brain, lung, heart and abdominal organs such as the liver, spleen, and kidney were examined at autopsy, whereas paranasal sinuses were not observed in detail. A rupture of the aneurysm in the superior wall of the left ICA was confirmed macroscopically (Figure 3A, 3B), and atherosclerosis was found in the left ICA microscopically. Microscopic findings of the aneurysm were pathologically characterized by destruction of the internal elastic lamina and media, and numerous infiltrating inflammatory cells in the aneurysmal wall. Grocott’s staining revealed septate hyphae with acute-angle branching, morphologically consistent with aspergillus species, located in the inflamed areas of the arterial and aneurysmal walls (Figure 4). Additionally, the serum Aspergillus antigens were positive in the previous days, the final pathological diagnosis was aneurysm caused by Aspergillus infection. Notably, Hyphae of Aspergillus existed more densely in the inner membrane than in the outer one. Considering the distribution of inflammatory changes and Aspergillus hyphae, it was reasonable to suppose that hematogeneous seeding rather than direct local invasion caused infectious aneurysm formation in the left ICA. However, evidence of Aspergillus infection was not found in any organs other than the left ICA.


Internal carotid artery blister-like aneurysm caused by Aspergillus - case report.

Ogawa M, Sakurai K, Kawaguchi T, Naiki-Ito A, Nakagawa M, Okita K, Matsukawa N, Shibamoto Y - Pol J Radiol (2015)

Hematoxylin and eosin stain revealed destruction of the elastica interna and media, and numerous infiltrating inflammatory cells in the aneurysmal wall. Destruction of the wall structures was more severe in the inner membrane than in the outer one. Grocott’s stain revealed Aspergillus hyphae in the inflamed areas of the arterial wall (inset).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4376144&req=5

f4-poljradiol-80-159: Hematoxylin and eosin stain revealed destruction of the elastica interna and media, and numerous infiltrating inflammatory cells in the aneurysmal wall. Destruction of the wall structures was more severe in the inner membrane than in the outer one. Grocott’s stain revealed Aspergillus hyphae in the inflamed areas of the arterial wall (inset).
Mentions: The brain, lung, heart and abdominal organs such as the liver, spleen, and kidney were examined at autopsy, whereas paranasal sinuses were not observed in detail. A rupture of the aneurysm in the superior wall of the left ICA was confirmed macroscopically (Figure 3A, 3B), and atherosclerosis was found in the left ICA microscopically. Microscopic findings of the aneurysm were pathologically characterized by destruction of the internal elastic lamina and media, and numerous infiltrating inflammatory cells in the aneurysmal wall. Grocott’s staining revealed septate hyphae with acute-angle branching, morphologically consistent with aspergillus species, located in the inflamed areas of the arterial and aneurysmal walls (Figure 4). Additionally, the serum Aspergillus antigens were positive in the previous days, the final pathological diagnosis was aneurysm caused by Aspergillus infection. Notably, Hyphae of Aspergillus existed more densely in the inner membrane than in the outer one. Considering the distribution of inflammatory changes and Aspergillus hyphae, it was reasonable to suppose that hematogeneous seeding rather than direct local invasion caused infectious aneurysm formation in the left ICA. However, evidence of Aspergillus infection was not found in any organs other than the left ICA.

Bottom Line: An 83-year-old man received corticosteroid pulse therapy followed by oral steroid therapy for an inflammatory pseudotumor of the clivus.Two months later, the patient was transported to an emergency department due to the diffuse subarachnoid hemorrhage, classified as Fisher group 4.Notably, that change was present more densely in the inner membrane than in the outer one.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.

ABSTRACT

Background: Blister-like aneurysm of the supraclinoid internal carotid artery (ICA) is a well-documented cause of subarachnoid hemorrhage. Generally, this type of aneurysm is associated with various conditions such as hypertension, arteriosclerosis, and ICA dissection. Although Aspergillus is the most common organism causing intracranial fungal aneurysmal formation, there is no report of a blister-like aneurysm caused by Aspergillus infection.

Case report: An 83-year-old man received corticosteroid pulse therapy followed by oral steroid therapy for an inflammatory pseudotumor of the clivus. Two months later, the patient was transported to an emergency department due to the diffuse subarachnoid hemorrhage, classified as Fisher group 4. Subsequent 3D computed tomography angiogram revealed a blister-like aneurysm at the superior wall of the left ICA. Six days later, the patient died of subarachnoid hemorrhage caused by the left ICA aneurysm rerupture. Autopsy revealed proliferation of Aspergillus hyphae in the wall of the aneurysm. Notably, that change was present more densely in the inner membrane than in the outer one. Thus, it was considered that Aspergillus hyphae caused infectious aneurysm formation in the left ICA via hematogenous seeding rather than direct invasion.

Conclusions: The blister-like aneurysm is a rare but important cause of subarachnoid hemorrhage. This case report documents another cause of blister-like aneurysms, that is an infectious aneurysm associated with Aspergillus infection.

No MeSH data available.


Related in: MedlinePlus