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1/7. Hypertrophic osteoarthropathy of one leg--a sign of aortic graft infection.

    We report a rare case of hypertrophic osteoarthropathy (HOA) confined to the right leg secondary to aortic graft infection. The development of HOA exclusively localized to areas distal to a vascular prosthesis may be the presenting manifestation of graft infection and a crucial diagnostic clue in the early detection of vascular graft infection. HOA is diagnosed by its characteristic radiographic and scintigraphic pattern. Most prosthetic, especially aortic, graft infections are uniformly fatal if not treated by aggressive surgical and antibiotic therapy. Recognition of this uncommon association may facilitate an early diagnosis, which usually requires immediate surgical therapy.
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ranking = 1
keywords = osteoarthropathy
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2/7. CT-guided aspiration biopsy of infected aortic graft in a patient with hypertrophic osteoarthropathy. Saline injection to improve diagnostic yield--a case report.

    Unilateral hypertrophic osteoarthropathy can be a diagnostic clue to chronic infection of an aortic graft and aorto-enteric fistula. In a 62-year-old woman, non-invasive diagnostic procedures failed to prove the infection. CT-guided fine needle biopsy revealed the pathogens prompting re-intervention. The biopsy result was markedly improved by injecting physiologic saline into the perigraft tissue.
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ranking = 1
keywords = osteoarthropathy
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3/7. osteomyelitis in a patient with a chronically infected arterial graft and longstanding hypertrophic osteoarthropathy of the leg.

    A patient is reported with hypertrophic osteoarthropathy of the right leg who developed an osteomyelitis; this appeared to be related to an infected aortic bifurcation prosthesis with increased uptake on leukocyte scan and chronic gas formation at the proximal aortic anastomosis on computed tomography. There have been previous reports of hypertrophic osteoarthropathy as a sign of arterial prosthesis infection. In this patient antibiotic therapy was successful in controlling the osteomyelitis but eradication of the arterial prosthesis infection could not be confirmed and an elective arterial operation involved too great a risk.
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ranking = 1.2
keywords = osteoarthropathy
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4/7. Monomelic hypertrophic osteoarthropathy secondary to aortic prosthesis infection.

    We describe a case of hypertrophic osteoarthropathy (HOA), exclusively located in the left lower leg and secondary to vascular prosthesis infection. Four years before, the patient underwent aortofemoral bifurcation grafting because of a ruptured aortic aneurysm. The investigations revealed prosthesis infection by Pseudomona aeruginosa and bacteroides thetaiotamicron. The onset of HOA in a patient with a vascular prosthesis can help to achieve an early diagnosis of graft infection. The literature on this uncommon association is reviewed.
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ranking = 1
keywords = osteoarthropathy
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5/7. Unilateral hypertrophic osteoarthropathy secondary to infected aortobifemoral graft and aortoenteric fistula.

    Localized hypertrophic osteoarthropathy is a reported manifestation of--and an important diagnostic clue to--infection of an aortic graft and aortoenteric fistula, two complications of vascular bypass surgery that carry a significant risk of mortality. This clue may lead to the early diagnosis essential to a successful outcome. The authors describe a patient with localized unilateral hypertrophic osteoarthropathy secondary to infection of an aortobifemoral graft and aortoenteric fistula.
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ranking = 1.2
keywords = osteoarthropathy
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6/7. Hypertrophic osteoarthropathy following aortic surgery.

    Unilateral lower extremity hypertrophic osteoarthropathy may be the initial symptom of an infected aortic graft. knowledge of this uncommon association should lead to early and accurate diagnosis and appropriate surgical management, thus avoiding the development of aortoenteric fistula, a complication that still carries a significant risk of mortality.
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ranking = 1
keywords = osteoarthropathy
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7/7. Subperiosteal new bone formation in association with vascular graft sepsis.

    Hypertrophic osteoarthropathy (HOA) is a clinical and radiologic syndrome that consists of periosteal new bone formation, synovitis, and digital clubbing. Secondary HOA has been reported confined to one or two extremities that are perfused by Dacron grafts that have become infected. Herein we include a report of a vascular graft infection that shares some of the clinical features with HOA and a brief review of pathophysiologic theories. We conclude emphasizing that periostitis and other HOA signs and symptoms may play a role as a clue to support the suspicion of vascular graft infection when confusing and vague clinical features are present.
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ranking = 0.2
keywords = osteoarthropathy
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