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Primary mycotic aneurysm of the thoracic aorta has rarely been reported. The patient was a 61-year-old male who had a ruptured mycotic aneurysm of the descending thoracic aorta without any evidence of infectious disorders in his history. The patient developed esophageal perforation after graft replacement of the descending thoracic aorta. After continuous irrigation of the left pleural cavity and the mediastinum for one month, the thoracic esophagus was resected and reconstructed. However, the patient died of DIC following uncontrolled sepsis on the 98th postoperative day. Pathogenesis of the esophageal perforation and operative procedures that might have been effective in saving the patient were discussed.
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