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Case Reports
. 2024 Jan 23;19(1):22.
doi: 10.1186/s13019-024-02504-5.

Distinguishing sterile inflammation from graft infection

Atsuyuki Mitsuishi  1 , Yujiro Miura  2 , Yu Arakawa  3 , Tatsuya Noguchi  4
Affiliations
Case Reports

Distinguishing sterile inflammation from graft infection

Atsuyuki Mitsuishi et al. J Cardiothorac Surg. .

Abstract

We describe the case of a 68-year-old man who underwent ascending aortic replacement and thoracic endovascular aortic repair. Four years later, the patient developed neck pain on the right side and chest computed tomography showed expansion of fluid in the mediastinum which had extended to the neck. Echocardiography revealed advanced severity of aortic regurgitation and decreased ejection fraction. Given the progression of aortic regurgitation, decreased cardiac function, and rapidly expanding fluid accumulation causing neck pain, reoperation was indicated. All microbiological test including polymerase chain reaction were negative indicating absence of any infection. The patient is being followed-up without antibiotics and CT has not shown peri-graft fluid 2 years postoperatively. Since infection cannot be excluded completely, it is important to assess the condition with selective medium, extended culture periods, genetic testing, and consultations with microbiology laboratories when normal culture tests for general bacteria, and fungi are negative which can help avoid drug-resistant bacteria count, elevated medical costs, and drug side effects due to the improper use of antibiotics through proper diagnosis.

Keywords: Fluid collection; Graft infection; Inflammation; Non-bacterial; Peri-graft; Sterile.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The CT value of peri-graft fluid collection (Blue color) was 30–40 HU
Fig. 2
Fig. 2
A, B (18)F-fluorodeoxyglucose ((18)F-FDG) positron-emission tomography (PET) before surgery. A The fluid in the mediastinum had expanded and extended to the right neck side (green arrow). B The PET confirmed 14.2 standardized uptake values max (SUV max) around prosthetic and stent graft
Fig. 3
Fig. 3
A, B Operative image (A) and schematic (B)
Fig. 4
Fig. 4
Algorism of microbiological test. PCR; Polymerase chain reaction
Fig. 5
Fig. 5
A, B (18)F-fluorodeoxyglucose ((18)F-FDG) positron-emission tomography (PET) 2 years after surgery. A, B The PET confirmed decreased to 3.1 standardized uptake values max (SUV max) around prosthetic and stent graft
See this image and copyright information in PMC

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