Overview
Splinter-related infections in the chest wall can lead to severe complications, including internal mammary artery pseudoaneurysms, particularly in pediatric populations, often secondary to staphylococcal or tuberculous chest wall abscesses. 1Diagnosis
Imaging findings indicative of internal mammary artery pseudoaneurysms, such as contrast enhancement and aneurysmal dilation on CT angiography or MRI.
Clinical signs of chest wall infection, including localized pain, swelling, and systemic inflammatory response.
Laboratory tests showing elevated inflammatory markers (e.g., CRP, ESR).
Culture and sensitivity testing of abscess aspirates to identify causative organisms (staphylococci, mycobacteria). 1Management
Endovascular therapy: Preferred method for treating pseudoaneurysms, involving catheter-based interventions to seal the aneurysm. 1
Antibiotics: Targeted therapy based on culture results; for staphylococcal infections, consider agents like vancomycin or linezolid. For mycobacterial infections, use second-line drugs such as rifampin, ethambutol, and isoniazid.
Surgical drainage: For abscesses that do not respond to endovascular or medical management, surgical intervention may be necessary.
Supportive care: Including fluid management, pain control, and monitoring for systemic complications. 1Special Populations
Pediatrics: Endovascular approaches are effective and minimize surgical risks in children with chest wall infections leading to pseudoaneurysms. 1
Comorbidities: Specific antibiotic choices should consider underlying conditions; for example, renal impairment may limit certain antibiotic options. 1Key Recommendations
Consider endovascular therapy as a first-line treatment for internal mammary artery pseudoaneurysms complicating chest wall infections, especially in pediatric patients. (Evidence: Moderate) 1
Initiate targeted antibiotic therapy based on culture and sensitivity results to address both staphylococcal and mycobacterial etiologies effectively. (Evidence: Moderate) 1
Monitor for systemic inflammatory response and manage complications surgically if endovascular and medical treatments fail. (Evidence: Expert opinion) 1References
1 Deshmukh H, Prasad SR, Patankar T, Zankar M. Internal mammary artery pseudoaneurysms complicating chest wall infection in children: diagnosis and endovascular therapy. Clinical imaging 2001. link00325-4)