Vascular Auto-Tamponade of an Infected (Mycotic) Aneurysm of the Aortic Arch and Innominate Artery
Bibliographic record
Abstract
Background: Infected aortic aneurysms pose significant therapeutic challenges, given the fragility of infected aneurysmal tissue. Mycotic aneurysms caused by Streptococcus agalactiae are rare and may progress in the absence of classical systemic infection signs. Here, we discuss the surgical management of an unusual presentation of a mycotic aneurysm and its rapid progression with no incremental changes in the patient’s symptoms. Case: A 72-year-old woman presented with subacute general deterioration and back pain. A general workup revealed a mycotic aneurysm of the aortic arch, at the level of the brachiocephalic artery. Initial CT showed a 7 × 5.5 mm pseudoaneurysm that enlarged to 41 × 26 mm within three weeks, despite clinical improvement of her presenting symptoms on antibiotics. Given that the lesion progressed, a staged procedure, consisting of a left carotid–subclavian bypass followed by proximal arch repair, was undertaken with success. Intra-operatively, a completely thrombosed innominate vein was found compressing—and likely tamponading—the pseudoaneurysm, a phenomenon that may have prevented catastrophic rupture. A Dacron graft was sewn end-to-end to the distal ascending aorta; the posterior half of this distal anastomosis incorporated the rim of the innominate artery defect to create a single hemostatic suture line. Conclusions: This case demonstrates a benign initial presentation can degenerate into a catastrophic pseudoaneurysm and how rapidly progressive thoracic infected aneurysms can develop. Heightened clinical acumen is required for accurate diagnosis. Close follow-up is also suggested based on the rapid progression experienced by our patient. Serial imaging, rather than symptomatic or laboratory response alone, should guide the timing of intervention.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".