Case Report | Published:

Mycotic thoracic aortic aneurysm producing vertebral body destruction and paraplegia: case report

Paraplegia volume 27, pages 406409 (1989) | Download Citation

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Abstract

In the surgical treatment of an aortic aneurysm, disruption of the blood supply to the spinal cord, resulting in paraplegia and anaesthesia below the level of involvement, is a dreaded complication. Occasionally, when an aortic aneurysm compresses a major vessel that supplies the anterior spinal artery, spinal cord ischaemia and paraplegia can occur before surgery. In the case presented here, however, preoperative paraplegia appears to have resulted from direct spinal destruction by an infected aortic aneurysm that was originally diagnosed as a spinal abscess. The patient underwent operative repair, but her aorta was so friable that the sutures would not hold. Despite repeat surgery, her condition rapidly proved fatal. This case shows that, in patients with a suspected spinal abscess, computer tomographic scanning and angiography should be performed to confirm the diagnosis and to rule out other pathological conditions. An accurate pre-operative diagnosis will permit adequate operative planning and prevent catastrophic results.

References

  1. 1.

    , , 1974 Mycotic aneurysms. Archives of Surgery 109: 712–717.

  2. 2.

    , 1972 Neurological complications of ruptured abdominal aortic aneurysm. British Journal of Surgery 59: 707–709.

  3. 3.

    , , et al 1984 Bacteriologic and surgical determinants of survival in patients with mycotic aneurysms. Journal of Vascular Surgery 4: 541–547.

  4. 4.

    , , et al 1982 Anterior spinal artery syndrome with chronic traumatic thoracic aneurysm. Annals of Thoracic Surgery 33: 81–85.

  5. 5.

    , , 1978 Cryptic mycotic abdominal aortic aneurysms: Diagnosis and management. American Journal of Surgery 136: 96–101.

  6. 6.

    , , et al 1979 Operative treatment of aortic dissections. Journal of Thoracic and Cardiovascular Surgery 78: 365–382.

  7. 7.

    , , 1972 Spinal cord injury after procedures on the aorta. Surgery Gynecology and Obstetrics 135: 29–34.

  8. 8.

    , 1977 Classification and management of mycotic aneurysms. Surgery Gynecology and Obstetrics 144: 691–694.

  9. 9.

    1976 Neurological complications of extraspinal arterial origin. American Surgeon 42: 679–684.

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Author information

Affiliations

  1. The Department of Surgery and the Department of Orthopedic Surgery, HCA Medical Center Hospital, Houston, Texas, USA

    • P A Rubio
    •  & P W Nelson

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Correspondence to P A Rubio.

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DOI

https://doi.org/10.1038/sc.1989.64

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