Published online May 15, 2006
PEDIATRICS Vol. 117 No. 6 June 2006, pp. e1259-e1262 (doi:10.1542/peds.2005-0897)
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EXPERIENCE AND REASON

Ductus Arteriosus Aneurysm With Community-Acquired Methicillin-Resistant Staphylococcus aureus Infection and Spontaneous Rupture: A Potentially Fatal Quandary

Audra Stewart, DOa, Umesh Dyamenahalli, MDa, S. Bruce Greenberg, MDb and Jonathan Drummond-Webb, MDc,{dagger}

a Departments of Pediatrics, Cardiology Division
b Radiology
c Section of Pediatric and Congenital Cardiac Surgery, University of Arkansas for Medical Sciences, College of Medicine, and Arkansas Children's Hospital, Little Rock, Arkansas

We present the case of a 6-month-old previously healthy girl who presented with high fever, labored breathing, and an enlarged cardiac silhouette on her chest radiograph. Comprehensive evaluation discovered a ductus arteriosus aneurysm and pericardial effusion with methicillin-resistant Staphylococcus aureus bacteremia. Despite pericardiocentesis and appropriate intravenous antibiotics, there was rapid enlargement of the aneurysm and accumulation of echogenic material within the ductus arteriosus aneurysm. Infected aneurysm rupture was identified during emergency surgery. This infant also had vocal cord paresis, a likely complication of the surgery. The clinical course, diagnosis, and treatment of this patient are discussed. Infection of a ductus arteriosus or an infected ductal arteriosus aneurysm is a rare and potentially fatal clinical entity. In the era of increasing community-acquired methicillin-resistant S aureus infections, this is a diagnosis that requires a high index of suspicion.

Key Words: pediatrics • cardiology • ductus arteriosus aneurysm

Abbreviations: DAA, ductus arteriosus aneurysm • PDA, patent ductus arteriosus • MRSA, methicillin-resistant Staphylococcus aureus • ED, emergency department • CT, computed tomography • CA, community acquired

Accepted Dec 22, 2005.