What question did this study set out to answer?

This review aims to synthesize evidence on Salmonella-associated mycotic aortic aneurysms and define hyper-rapid progression as a significant indicator for clinical action.

March 26, 2026Radiology and Oncology0 citationsOpen Access

Hyper-rapid progression in Salmonella-associated mycotic aortic aneurysms: a narrative review

JLJernej Lučev VFVojko Flis ASAleš Slanič

Key Points

This review aims to synthesize evidence on Salmonella-associated mycotic aortic aneurysms and define hyper-rapid progression as a significant indicator for clinical action.
Conducted a narrative review of existing literature on Salmonella-associated mycotic aortic aneurysms.
Introduced hyper-rapid progression as an early imaging biomarker for this condition.
Analyzed the implications of surgical and endovascular interventions in managing these aneurysms.
Defined hyper-rapid progression as aortitis to pseudoaneurysm growth within 7 days or enlargement in 72 hours despite antibiotics.
Identified Salmonella MAAs as high-risk with potential for explosive growth.
Highlighted that while open surgical repair is standard, complex endovascular options can be life-saving for high-risk patients.

Abstract

Abstract Background Mycotic aortic aneurysms (MAAs), or infective native aortic aneurysms, are rare, life-threatening infections with a high risk of rupture. Non-typhoidal Salmonella (NTS) species show a tropism for the diseased aorta in elderly, atherosclerotic patients, causing explosive growth poorly captured by conventional surveillance. Management is complex when the visceral/paravisceral aorta is involved, making open surgical repair (OSR) risky and requiring tailored endovascular aortic repair (EVAR). This review synthesises evidence on Salmonella -associated MAAs and introduces hyper-rapid progression (HRP) as an early imaging biomarker. Conclusions Salmonella MAAs represent a high-velocity phenotype. We define HRP as progression from aortitis to saccular pseudoaneurysm (≥ 5 mm) within 7 days or rapid enlargement (≥ 5 mm or > 50%) within 72 hours despite antibiotics. HRP serves as a “red flag” for urgent mechanical stabilisation. While OSR is the gold standard, in anatomically complex or high-risk patients, complex EVAR with parallel grafts and an optimized radial sealing strategy (ORSS) offers a life-saving alternative. Prospective validation of HRP and its integration into imaging algorithms are needed to improve survival in this devastating condition.

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