A vascular surgeon was needed to review the case of a young woman after she passed away under a hospital’s care. A user of intravenous drugs, she was admitted to the hospital’s emergency services after complaining of muscle pain, fever, and multiple abscesses. She was diagnosed with tricuspid valve endocarditis and extensive bacterial contamination of the heart, septic arthritis in her right elbow, infectious methicillin-resistant staphylococcus aureus bacteremia, and abscesses in her lungs and left shoulder. She began to have abdominal pain and recurrent fevers, and imaging revealed an expanding abdominal aortic mycotic pseudoaneurysm from bacterial infection, indicating that there was bacteria growing inside her heart. A computed tomography angiogram of the patient’s thorax, abdomen, and pelvis revealed that she had suffered an acute aortic pseudoaneurysm rupture, with fluid leaking into the cavity behind her abdomen. She had also developed a hematoma in the same cavity, and the fluid had spread into a paracolic gutter, lying between her colon and abdominal wall. Though she was rushed to the operating room, she passed away while on the table.
Question(s) For Expert Witness
1. Do you treat and evaluate patients similar to the one described?
2. How common is it for patients with abdominal aortic aneurysms to have this outcome/ complication?
Expert Witness Response E-032659
I routinely treat patients with this clinical condition in my practice. Death is always a potential risk for patients with ruptured abdominal aortic aneurysms, but it is imperative to see if the treatment guidelines for managing this surgical emergency were used.
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