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Infected aortic and iliac aneurysms:Clinical manifestations in the emergency departments of two hospitals in southern Taiwan, China

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Chang-Chih Tsai1, Chien-Chin Hsu2, Kuo-Tai Chen3

 

1 Emergency Department, Chi-Mei Medical Center, Tainan, China

 

2 Department of Biotechnology, Southern Tainan University of Technology, Tainan, China

 

3 Department of Emergency Medicine, Taipei Medical University, Taipei, China

 

Corresponding Author: Kuo-Tai Chen, Email: 890502@mail.chimei.org.tw

 

© 2017 World Journal of Emergency Medicine

 

DOI: 10.5847/wjem.j.1920–8642.2017.02.007

 

BACKGROUND: Accurate diagnosis of infected aortic and iliac aneurysms is often delayed, hampering timely treatment and potentially resulting in a fatal consequence. The aim of this study was to discover useful clinical features that can help physicians to identify these patients.

METHODS: We reviewed the discharge notes from two hospitals and identified all patients who had a diagnosis of infected aneurysms of the thoracoabdominal aorta and iliac arteries between July 2009 and December 2013. Eighteen patients, aged from 41 to 93, were reviewed. Only 6 patients were diagnosed accurately in their first visit to our ED.

RESULTS: Most patients had at least one underlying illness, and it took 1 to 30 (9.9±6.5) days for physicians to diagnose their infected aneurysm. Localized pain and fever were the two most commonly presented symptoms. The majority (92%) of isolated microorganisms were gram-negative bacilli, including Salmonella spp, Klebsiella pneumoniae, and Escherichia coli. Two of the 3 patients who underwent non-operative therapy died, and all of the patients who underwent a combination of medical and operative therapies survived.

CONCLUSION: We suggest that physicians liberally use computed tomography scans on patients with unknown causes of pain and inflammatory processes. A combination of surgical and medical treatments is indicated for all patients with infected aortic and iliac aneurysms.

(World J Emerg Med 2017;8(2):121–125)

 

KEY WORDS: Infected aneurysm; Salmonella; Misdiagnosis; Emergency department; Clinical manifestation

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