0:00

So this patient has a history of bypass grafts, stents,

0:04

basically multiple vascular interventions.

0:07

And the reason we're trying to learn from this scan is because they

0:11

had an infection of sites of these vascular

0:15

interventions. So as we're scrolling down this

0:18

arterial phase scan,

0:21

obviously there's a complex dissection flap that we see here in this

0:25

distal left common iliac artery, multiple

0:28

atherosclerosis, but we're really just going to focus on the infection

0:32

component process in this scan.

0:35

So as we're scrolling down to this external iliac artery,

0:39

again, we notice both surgical changes in both the inguinal regions.

0:43

We're looking at the bypass graft coming out.

0:45

We're looking at the native vessel, which has a stent within.

0:49

But in addition to all of these findings, we're seeing that there's fluid

0:53

all along it, and along with the fluid, there is also air

0:57

foci within the collection.

0:59

Now, that's one of the more common appearances

1:03

of an infection. You'd see a fluid collection, you can see air

1:07

foci. But before determining that a fluid collection and an air

1:11

foci are really related to infection, it's important to look at it in a

1:15

clinical context. This person, turned out, had positive blood

1:19

cultures, they had fevers,

1:21

and they didn't have a history of really recent prior

1:25

intervention. If this patient didn't have fever

1:29

and had a recent intervention, then this could just be a normal

1:33

post-surgical change. And so really, clinical context is

1:37

really important in all of these things.

1:40

But more concerning here, which I think was the clue, and even

1:44

if this person did have a recent history of intervention and why we should have

1:47

brought up an infection in this case, is that if you look at the stent

1:51

inside, the stent also has an air focus within.

1:55

So if I widen my window here, it's not just an occluded stent, but there's

1:59

also air within. So not only is this bypass graft

2:03

occluded, but that native occluded stent is also

2:06

infected. The rest of that bypass graft was actually patent.

2:10

This patient underwent a wound culture where they found

2:14

MSSA, and they underwent debridement and antibiotic

2:18

irrigation. And you can see how patent that bypass

2:21

graft to the anterior tibial artery is.

2:24

So this

2:25

femoral to anterior tibial artery bypass graft is patent.

2:28

It's just that there's an infection around it and in that native vessel.