Primary Mycotic Aneurysms of the Aorta

Abstract

SINCE Osler's description in 1885 of a case of aneurysm associated with bacterial endocarditis, the term "mycotic" has been applied to aneurysms arising from non-syphilitic infection of a blood vessel wall.¹ Before the advent of antibiotics these lesions were not rare, for Stengel and Wolferth reviewed the literature in 1923 and recorded 217 cases.² In all of their collected cases a primary focus of infection was identified which could have provided the source for the bacterial infection of the vessel wall. Bacterial endocarditis was by far the most common source of infection (86%), with pneumonia and osteomyelitis next in frequency. A more recent review by Goadby et al in 1949 also revealed endocarditis as the most frequent etiologic factor (95%).³ A striking feature of Stengel and Wolferth's series was the predominance of lesions in central arteries, with the aorta being most often involved (30%), closely followed by