Mycotic aneurysms--a challenge and a clue. Review of ten-year experience

A review of the records of the past ten years at Temple University Hospital, Philadelphia, yielded 11 mycotic aneurysms in eight patients. Despite antibiotics, mycotic aneurysms remain an infrequent but serious threat to health and often to life. No age, sex, or anatomic part is immune. Bacterial endocarditis and atheromatous disease both increase vulnerability to these lesions. The clinical presentation of mycotic aneurysms may be very subtle, or may give dramatic evidence of hitherto unrecognized underlying disease. Angiography readily demonstrates the aneurysms which confirms the diagnosis and guides the surgeon. Extirpation of the aneurysms is necessary for cure. Placement of a prosthetic into an infected bed is unsatisfactory. Preoperative angiography is prudent in any patient with a mediastinal mass which cannot be radiologically separated from the heart.