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• W3198151601 abstract "HomeRadioGraphicsVol. 41, No. 5 PreviousNext Cases from the Cooky JarFree AccessClostridium Septicum AortitisAditya Khurana, Ciléin Kearns, Anna Sophia McKenney, Ahmed M. Gabr Aditya Khurana, Ciléin Kearns, Anna Sophia McKenney, Ahmed M. Gabr Author AffiliationsFrom the Department of Radiology, Mayo Clinic, Rochester, MN (A.K.); Medical Research Institute of New Zealand, Wellington, New Zealand, and Artibiotics, Wellington, New Zealand (C.K.); Division of Interventional Radiology, Department of Radiology, NewYork–Presbyterian Weill Cornell Medicine, New York, NY (A.S.M.); and Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Va (A.M.G.).Address correspondence to A.M.G., Department of Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239 (e-mail: [email protected]).Aditya KhuranaCiléin KearnsAnna Sophia McKenneyAhmed M. Gabr Published Online:Sep 1 2021https://doi.org/10.1148/rg.2021210178MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Clostridium septicum is a motile, gram-positive, spore-forming, gas-producing anaerobic bacillus. Although it is not typical normal flora of the gastrointestinal tract, it has been reported to be present in 10%–63% of normal appendices. Because 85% of C septicum infections are associated with an underlying gastrointestinal or hematologic malignancy, an exhaustive search for an occult malignancy is warranted if one has not already been identified (1). C septicum–associated colon carcinomas and/or intra-abdominal infections can lead to seeding of the aorta, which causes inflammation of the vessel wall resulting in disruption and gas infiltration of the layers of the aortic wall, and complications of acute aortic dissection and aneurysm have been reported (2). C septicum aortitis is exceedingly rare, and the reported overall mortality rate is estimated to be 64% within 6 months and 100% without operative intervention (2) (Figs 1–3).Figure 1a. C septicum aortitis in a 63-year-old man who presented with acute abdominal pain. (a) Axial (left) and coronal (right) contrast-enhanced CT images show several foci of mottled gas (arrows) within the ulcerated wall of the abdominal aorta, with perivascular inflammation. (b) Axial (left) and coronal (right) contrast-enhanced CT images (lower level than in a and b) show a large, nearly obstructing cecal mass straddling the ileocecal valve (arrows), a finding consistent with a primary malignancy. (c, d) Colonoscopic image (c) and photomicrograph (d) help confirm the diagnosis. In d, Gram stain shows aggregates of blue-purple gram-positive bacilli (arrow) infiltrating the aortic wall.Figure 1a.Download as PowerPointOpen in Image Viewer Figure 1b. C septicum aortitis in a 63-year-old man who presented with acute abdominal pain. (a) Axial (left) and coronal (right) contrast-enhanced CT images show several foci of mottled gas (arrows) within the ulcerated wall of the abdominal aorta, with perivascular inflammation. (b) Axial (left) and coronal (right) contrast-enhanced CT images (lower level than in a and b) show a large, nearly obstructing cecal mass straddling the ileocecal valve (arrows), a finding consistent with a primary malignancy. (c, d) Colonoscopic image (c) and photomicrograph (d) help confirm the diagnosis. In d, Gram stain shows aggregates of blue-purple gram-positive bacilli (arrow) infiltrating the aortic wall.Figure 1b.Download as PowerPointOpen in Image Viewer Figure 1c. C septicum aortitis in a 63-year-old man who presented with acute abdominal pain. (a) Axial (left) and coronal (right) contrast-enhanced CT images show several foci of mottled gas (arrows) within the ulcerated wall of the abdominal aorta, with perivascular inflammation. (b) Axial (left) and coronal (right) contrast-enhanced CT images (lower level than in a and b) show a large, nearly obstructing cecal mass straddling the ileocecal valve (arrows), a finding consistent with a primary malignancy. (c, d) Colonoscopic image (c) and photomicrograph (d) help confirm the diagnosis. In d, Gram stain shows aggregates of blue-purple gram-positive bacilli (arrow) infiltrating the aortic wall.Figure 1c.Download as PowerPointOpen in Image Viewer Figure 1d. C septicum aortitis in a 63-year-old man who presented with acute abdominal pain. (a) Axial (left) and coronal (right) contrast-enhanced CT images show several foci of mottled gas (arrows) within the ulcerated wall of the abdominal aorta, with perivascular inflammation. (b) Axial (left) and coronal (right) contrast-enhanced CT images (lower level than in a and b) show a large, nearly obstructing cecal mass straddling the ileocecal valve (arrows), a finding consistent with a primary malignancy. (c, d) Colonoscopic image (c) and photomicrograph (d) help confirm the diagnosis. In d, Gram stain shows aggregates of blue-purple gram-positive bacilli (arrow) infiltrating the aortic wall.Figure 1d.Download as PowerPointOpen in Image Viewer Figure 2. Overview of C septicum aortitis pathologic findings. (Reprinted, with permission, from Ciléin Kearns, Artibiotics, Copyright © 2021.)Figure 2.Download as PowerPointOpen in Image Viewer Figure 3. Connection between C septicum aortitis and gastrointestinal malignancy. (Reprinted, with permission, from Ciléin Kearns, Artibiotics, Copyright © 2021.)Figure 3.Download as PowerPointOpen in Image Viewer References1. Rucker CM, Menias CO, Bhalla S, Geraghty P, Heiken JP. Clostridium septicum infrarenal aortitis secondary to occult cecal adenocarcinoma. AJR Am J Roentgenol 2004;183(5):1316–1318. Crossref, Medline, Google Scholar2. Seder CW, Kramer M, Long G, Uzieblo MR, Shanley CJ, Bove P. Clostridium septicum aortitis: report of two cases and review of the literature. J Vasc Surg 2009;49(5):1304–1309. Crossref, Medline, Google ScholarArticle HistoryReceived: June 06 2021Accepted: June 08 2021Published online: Sept 01 2021Published in print: Sept 2021 FiguresReferencesRelatedDetailsRecommended Articles Single-Center Analysis of Pegfilgrastim-induced Aortitis Using a Drug Prescription Database and CT FindingsRadiology2022Volume: 305Issue: 3pp. 729-740A Large-Vessel Arteritis in SARS-CoV-2–related Multisystem Inflammatory Syndrome in ChildrenRadiology: Cardiothoracic Imaging2021Volume: 3Issue: 1IgG4-related Cardiovascular Disease from the Aorta to the Coronary Arteries: Multidetector CT and PET/CTRadioGraphics2018Volume: 38Issue: 7pp. 1934-1948Syphilitic Aortitis with Coronary Ostial Involvement: AIRP Best Cases in Radiologic-Pathologic CorrelationRadioGraphics2017Volume: 37Issue: 2pp. 407-412Aortic Fistulas: Pathophysiologic Features, Imaging Findings, and Diagnostic PitfallsRadioGraphics2021Volume: 41Issue: 5pp. 1335-1351See More RSNA Education Exhibits Inflammatory Conditions Of The Aorta: A Pictorial ReviewDigital Posters2021Aortitis In the Emergency RoomDigital Posters2020Fat Stranding as a Clue to Help in Emergency CasesDigital Posters2019 RSNA Case Collection Coral Reef AortaRSNA Case Collection2022Cecal volvulusRSNA Case Collection2020Cardiovocal SyndromeRSNA Case Collection2022 Vol. 41, No. 5 Metrics Altmetric Score PDF download" @default.
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