Presentation, Diagnosis, and Management of Arterial Mycotic Pseudoaneurysms in Injection Drug Users
| Autor: | Allan I. Bloom, Jack W. Tsao, Shelley R. Marder, Jerry Goldstone |
|---|---|
| Rok vydání: | 2002 |
| Předmět: |
Adult
Male Emergency Medical Services medicine.medical_specialty Population Physical examination Aneurysm Ruptured Diagnosis Differential Aneurysm Prevalence medicine Humans Endocarditis Substance Abuse Intravenous Abscess education Retrospective Studies Ultrasonography Doppler Duplex education.field_of_study medicine.diagnostic_test Heroin Dependence business.industry Urban Health Disease Management Sequela General Medicine Middle Aged medicine.disease Surgery Treatment Outcome Cellulitis Angiography Female Radiology Tomography X-Ray Computed Cardiology and Cardiovascular Medicine business Aneurysm Infected Aneurysm False |
| Zdroj: | Annals of Vascular Surgery. 16:652-662 |
| ISSN: | 0890-5096 |
| DOI: | 10.1007/s10016-001-0124-6 |
| Popis: | Injection drug users frequently present with abscess, cellulitis, and endocarditis. The development of arterial mycotic pseudoaneurysm (AMP) as a sequela of injection drug use, however, is much less frequently reported. We undertook a study to determine the prevalence and presenting clinical characteristics of AMP, utilizing a retrospective review of all emergency department cases seen at one city public hospital for the 5-year period 1994-1999. Initial evaluation included physical examination, CT scan, ultrasound, and/or angiography. There were 7,795 patient visits for complications of injection drug use; 11 patients had AMP (0.14%). AMP involved the brachial (n = 5), subclavian (n = 2), radial (n = 2), femoral (n = 1) and popliteal arteries (n = 1). Fever was absent in the majority of patients (7/11). Either pulsatility or a mass was noted in three cases, and both were seen in 6/11 (54%). AMP was not initially suspected in three cases, which were treated as abscesses and surgically incised, resulting in arterial rupture. The annual prevalence of AMP in the presenting population was estimated to be 0.03%. However, a high index of suspicion for AMP should be maintained with injection drug users presenting with a mass or pulsatility over an artery, as there is risk of rupture, rapid exsanguination, and distal embolization. |
| Databáze: | OpenAIRE |
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