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Aneurysm : A Focal Dilation Of An Infected Arterial Wall

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Mycotic aneurysm is a focal dilation of an infected arterial wall. This uncommon disease follows an aggressive and unpredictable clinical course with significant mortality, and presents unique diagnostic and therapeutic challenges. This review discusses the pathogenesis, diagnosis, and therapeutic management of mycotic aneurysms.

Historical Perspective Virchow first described a saccular outpoutching along an arterial wall corresponding to an embolic source in 1847 [1]. Mycotic aneurysms were initially considered a physical change secondary to mechanical pressure of emboli against the artery wall [2]. Infectious etiology was first hypothesized by Goodhart in 1877 [3]. The term ‘mycotic’ originates from Osler’s Gulstonian Lectures in 1885 [4] in which he associated aortic aneurysms resembling a fungus growth with a severe or “malignant” form of endocarditis and coined the term “mycotic aneurysms.” The term “mycotic” is a misnomer suggesting fungal infection, though it was originally intended to refer to all microorganisms [5]. Osler established a clear connection between endocarditis and its bacterial origin (“micrococci”) through histology using bacterial Gram staining, which at the time was novel in medical practice. He defined the mycotic process in the setting of endocarditis as the transference of microbes from the growth of the valves to distant parts. In 1887, Langton and Bowlby corroborated Osler’s findings with observations of numerous bacteria derived from the

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