Contrast-Enhanced Ultrasound in a Case of an Intrahepatic Mycotic Aneurysm

Introduction

Mycotic aneurysms (MA) are infrequent though important complications of a subset of infections with infective endocarditis (IE) being the most common cause [W. R. Wilson et al. Circulation vol. 134,20 (2016): e412–e460]. MAs can arise in every artery and the mortality of visceral Mas, in particular, is high. Immediate diagnosis and early intervention are, therefore, essential for the management of VMA. Only a few patients present with overt clinical symptoms like abdominal pain, obstructive jaundice, or hemobilia [M. A. Abbas, et al. “Journal of vascular surgery vol. 38,1 (2003): 41–45]. However, American IE guidelines recommend computed tomography only in symptomatic patients and European guidelines do not give any advice on the management of VMA [G. Habib et al. European Heart Journal, Volume 36, Issue 44, 21 November 2015, Pages 3075–3128; L. M. Baddour, et al. Circulation vol. 132,15 (2015): 1435–1486]. Hence, diagnosis is often deferred until severe complications like rupture and subsequent hemorrhagic shock occur.

Contrast-enhanced ultrasound (CEUS) is a viable tool for the classification of abdominal lesions [C. F. Dietrich et al. Ultraschall in Med vol. 41,5 (2020): 562–585]. However, data on the value of CEUS in infective endocarditis for the diagnosis of VMA is scarce. We report the case of a young woman with IE and a clinically silent giant intrahepatic MA, which was diagnosed and characterized via qualified bedside CEUS. Therapeutic endovascular intervention was performed immediately and likely prevented a life-threatening hemorrhage.

Publikationsverlauf

Eingereicht: 16. Juli 2022

Angenommen nach Revision: 31. August 2022

Artikel online veröffentlicht:
30. September 2022