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Case Reports
. 2018 May 7:2018:7080813.
doi: 10.1155/2018/7080813. eCollection 2018.

Mycotic Renal Artery Aneurysm Presenting as Critical Limb Ischemia in Culture-Negative Endocarditis

Vy Thuy Ho  1 , Nathan K Itoga  1 , Tiffany Wu  1 , Ehab Sorial  1 , Manuel Garcia-Toca  1
Affiliations
Case Reports

Mycotic Renal Artery Aneurysm Presenting as Critical Limb Ischemia in Culture-Negative Endocarditis

Vy Thuy Ho et al. Case Rep Surg. .

Abstract

Mycotic renal artery aneurysms are rare and can be difficult to diagnose. Classic symptoms such as hematuria, hypertension, or abdominal pain can be vague or nonexistent. We report a case of a 53-year-old woman with a history of intravenous drug abuse presenting with critical limb ischemia, in which CT angiography identified a mycotic renal aneurysm. This aneurysm tripled in size from 0.46 cm to 1.65 cm in a 3-week interval. Echocardiography demonstrated aortic valve vegetations leading to a diagnosis of culture-negative endocarditis. The patient underwent primary resection and repair of the aneurysm, aortic valve replacement, and left below-knee amputation after bilateral common iliac and left superficial femoral artery stenting. At 1-year follow-up, her serum creatinine is stable and repaired artery remains patent.

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Figures

Figure 1
Figure 1
Lower extremity physical exam findings leading to the further workup of embolic and infectious sources, Osler nodes on the right foot, and decreased perfusion of the left leg due to proximal arterial occlusion in the iliac and superficial femoral arteries.
Figure 2
Figure 2
CT axial images demonstrating (a) normal caliber left renal artery 3 weeks prior to presentation, (b) 1.65 cm left renal artery aneurysms, and (c) 3D reconstruction of left renal artery aneurysm (arrow).
Figure 3
Figure 3
Operative exposure during left renal artery aneurysm (arrow) resection and repair. Proximal and distal control is obtained, and the left renal vein is retracted cephalad.
See this image and copyright information in PMC

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