Background: Mycotic aortic aneurysm represents an infrequent but life-threatening disease usually affecting old, male, and immunocompromised subjects with pre-existing aneurysms. Methods: We describe the case of a 69-year-old man with a history of cardiopathy and coagulopathy, admitted to our hospital due to intractable abdominal pain and marked hypotension. In the suspicion of aortic acute syndrome, the patient undergoes CT-angiography of the aorta, showing aneurysm of the infra-renal tract with thrombosis and peri-aortic soft tissue in contact with the third portion of the duodenum, raising suspicion for a mycotic aortic aneurysm with aorto-enteric fistula. The patient is thus in need of emergency vascular surgery, confirming CT findings. Result: positivity of the infective tissue for Staphylococcus Aureus is seen; despite the good technical success, the patient dies due to the sequelae of shock. Discussion: Early diagnosis is challenging because of non-specific clinical and laboratory findings, CT thus representing the gold standard for diagnosis, quantification of aortic disease, relationship with nearby organs, and potential sources of infection (unknown in 30% of cases). Mycotic aneurysms are prone to rupture, sometimes leading to fistulization with the duodenum, bronchi, or inferior vena cava, often associated with life-threatening hemorrhages. Treatment options are conventional open surgical or endovascular repair.

Parotid sialocele is a challenging complication following major salivary gland surgery. Traditional conservative management often fails, while revision surgery carries a high risk of iatrogenic facial nerve injury. This retrospective, single-center case series evaluated the clinical efficacy and safety of ultrasound-guided Botulinum Toxin Type A (BoNT-A) infiltration in eight consecutive patients presenting with post-surgical parotid sialoceles. The protocol comprised complete ultrasound-guided evacuative aspiration followed by intraglandular injections of OnabotulinumtoxinA into functional parenchyma using a standardized grid mapping technique. Dosage was individualized based on the sonographic estimation of the residual volume of glandular tissue. Post-procedure care included a soft diet, temporary avoidance of sialagogues, and strict avoidance of local massage for 24 h. Complete clinical and sonographic resolution was achieved in all 8 treated cases within a mean interval of 10 days post-injection. Follow-up at 3 months confirmed no recurrences or late-onset complications. No local or systemic adverse events were recorded. In this preliminary case series, ultrasound-guided intraglandular BoNT-A injection represented a safe and encouraging minimally invasive second-line option for post-surgical parotid sialoceles.