Aortic pseudoaneurysm as a rare complication of purulent pericarditis: case report and literature review

Background Purulent pericarditis has become rare in the antibiotic era, particularly when complicated by secondary infections such as an aortic pseudoaneurysm. Case presentation We report a 46-year-old man who presented with persistent chest pain and cold sweats for three days. Imaging revealed a large pericardial effusion, and cultures grew methicillin-resistant Staphylococcus aureus (MRSA). The patient underwent partial pericardiectomy with delayed sternal closure and open irrigation. On day 23, he developed right shoulder pain, and imaging revealed a pseudoaneurysm of the ascending aorta. Thoracic endovascular aortic repair combined with bovine pericardial patch repair was performed. He survived and remained stable during a 13-month outpatient follow-up. Conclusion Given the potential for fatal outcomes, clinicians should maintain a high index of suspicion and initiate prompt management, despite the rarity of this complication.