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題名 | Empyema in Mycotic Aneurysm Rupture and Salmonellosis--A Case Report=菌病性動脈瘤破裂及沙門桿菌病導致膿胸之病例報告 |
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作者 | 許文瑞; 溫仁和; 楊良友; 楊文義; | 書刊名 | 胸腔醫學 |
卷期 | 16:1 2001.03[民90.03] |
頁次 | 頁73-79 |
分類號 | 415.432 |
關鍵詞 | 菌病性動脈瘤; 沙門桿菌病; 膿胸; Mycotic aneurysm; Salmonellosis; Empyema; |
語文 | 英文(English) |
中文摘要 | 菌病性動脈瘤破裂及沙門桿菌菌血症以膿胸作為臨床表現極為罕見。一般而言,菌病性動脈瘤是經戰動脈硬化血管內血行性感染而造成。菌病性主動脈瘤常可致命,因為其病程會引發敗血症及血管破裂,因此早期診斷治療對癒後極有必要。菌病性動脈瘤臨床症狀表現沒有特異性,易造成診斷上的困擾,除非有即時的電腦斷層或血管攝影分析。 此病例以沙門桿菌菌血症及膿胸診斷而後以腹部電腦斷層診斷菌病性動脈瘤破裂,再由外科緊急施行動脈瘤切除術。血液、膿胸滲出液、及動脈瘤組織培養均證實沙門桿菌感染;病理切片則證實有動脈硬化及血栓壞死組織。菌病性動脈瘤在未詳細診斷前可以抗生素治療,特診斷出來之後則必須以外科手術施行動脈瘤切除而不可單以抗生素控制感染。 |
英文摘要 | Empyema is a rare complication of mycotic aneurysm and salmonella bacteremia. Mycotic aneurysm generally results from the hematogenous infection of a previously damaged arteriosclerotic vessel. Mycotic aneurysm of the aorta is a life-threatening condition because of its natural course toward generalized sepsis and rupture. Surgical interventioin after aneurysmal rupture carries a high risk of morbidity and mortality. Therefore, early intervention is essential for the final outcome. Mycotic aneurysm of the aorta usually presents with vague or nonspecific symptoms, which often hinder the correct diagnosis until a computer tomograhic (CT) scan or an aortograph is obtained. Treatment of mycotic aneurysm begins with appropriate antibiotics. Clinical improvement with antibiotic treatment should not exclude the need for surgical intervention. We present this unusual case of a patient who was initially diagnosed with salmonella bacteremia and empyema. An abdominal CT was promptly obtained and the diagnosis of mycotic aneurysm rupture was made. Blood, pleural fluid, and tissue cultures grew Salmonella Enteritidis. The pathology report revealed an aortic wall with atherosclerotic change, organizing thromibi , and necrotic tissue. |
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