Infected Splenic Artery Aneurysm Secondary to Infective Endarteritis in a Child with Supravalvular Aortic Stenosis

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  • Kawamukai Hisaki
    Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences Department of Pediatrics, Gamagori City Hospital
  • Shinohara Tsutomu
    Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences
  • Koyama Satoshi
    Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences
  • Nakagawa Motoo
    Department of Radiology, Nagoya City University Graduate School of Medical Sciences
  • Shimohira Masashi
    Department of Radiology, Nagoya City University Graduate School of Medical Sciences
  • Sato Emi
    Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences
  • Fujimoto Masanori
    Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences
  • Hattori Yukinori
    Department of Pathology, Japan Community Health Care Organization, Chukyo Hospital
  • Osawa Takuya
    Department of Cardiovascular Surgery, Japan Community Health Care Organization, Chukyo Hospital
  • Watanabe Tamao
    Department of Pediatrics, Gamagori City Hospital
  • Sakurai Hajime
    Department of Cardiovascular Surgery, Japan Community Health Care Organization, Chukyo Hospital
  • Suzuki Kazutaka
    Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences
  • Saitoh Shinji
    Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences

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Abstract

<p>Infected splenic artery aneurysm (SAA) is a rare but serious complication associated with infective endocarditis or endarteritis (IE), which could cause sudden death due to aneurysm rupture. In some occasions, surgical or endovascular treatment is urgently required to prevent rupture. No recommended therapeutic strategy has been established in children with infected SAA, since only a few pediatric patients have been reported. Here, we report a case in which we detected a 10 mm SAA due to IE in a 10-year-old patient with familial supravalvular aortic stenosis. The patient had not been on any antibiotics before visiting our hospital; being afebrile and complaining pain in his extremities. Transthoracic echocardiography revealed multiple vegetations in the aortic arch. Blood culture results indicated the presence of Abiotrophia defectiva. Multiple embolisms were detected in his spleen and both kidneys on abdominal contrast-enhanced computed tomography (CT). After surgery to remove those vegetations, penicillin therapy was continued. A SAA was noted serendipitously on follow-up contrast CT. We successfully coil-embolized the SAA on a semi-urgent basis; no rupture of the aneurysm nor recurrence of IE. This report documents IE due to Abiotrophia defectiva causing an arterial aneurysm, e.g. at the splenic artery, and suggests a treatment option for pediatric SAA.</p>

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