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Yoshito Homma, Harada T, Inoue T, Nakamura J, Kondo H, Tachibana S, Katsuta T, Inoue K. Tuberculous aneurysm diagnosed by CT-Guided biopsy after stent graft replacement: A case report. J Infect Chemother 2024:S1341-321X(24)00112-0. [PMID: 38583801 DOI: 10.1016/j.jiac.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/27/2024] [Accepted: 04/03/2024] [Indexed: 04/09/2024]
Abstract
A tuberculous aneurysm is an uncommon extrapulmonary tuberculosis and is usually fatal. The best way to treat it involves a combination of open surgery and medical treatment. However, it can be challenging to diagnose a tuberculous aneurysm. In this report, we describe a patient with a tuberculous aneurysm who was treated with stent-graft replacement and CT-guided biopsy for diagnosis, followed by nine months of anti-tuberculosis therapy. Despite one week of anti-tuberculous therapy, her fever persisted. A CT scan revealed new, well-defined nodules measuring 1-2mm in the lungs and hepatomegaly, indicating complications of miliary tuberculosis. After three weeks after the CT-guided biopsy, Mycobacterium tuberculosis grew from the arterial wall tissue, leading to the diagnosis of a tuberculous aneurysm complicated by miliary tuberculosis. The patient's aneurysm disappeared on follow-up CT scans, and the patient has been under observation for five years without a relapse. This rare case of tuberculous aneurysm can provide lessons for countries with a low prevalence of tuberculosis. This suggests the possibility of treatment with stent-graft replacement and anti-tuberculous medication and the usefulness of CT-guided biopsy for microbiological and pathological diagnosis.
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Affiliation(s)
- Yoshito Homma
- Department of Infectious Diseases, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama City, Ehime, 790-0024, Japan.
| | - Takashi Harada
- Department of Cardiovascular Surgery, Fukuyama Cardiovascular Hospital, 2-39 Midori-cho, Fukuyama City, Hiroshima, 720-0804, Japan
| | - Takeshi Inoue
- Department of Radiology, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama City, Ehime, 790-0024, Japan
| | - Junya Nakamura
- Department of Respiratory Medicine, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama City, Ehime, 790-0024, Japan
| | - Haruka Kondo
- Department of Respiratory Medicine, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama City, Ehime, 790-0024, Japan
| | - Sayaka Tachibana
- Department of Respiratory Medicine, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama City, Ehime, 790-0024, Japan
| | - Tomoya Katsuta
- Department of Respiratory Medicine, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama City, Ehime, 790-0024, Japan
| | - Koji Inoue
- Department of Respiratory Medicine, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama City, Ehime, 790-0024, Japan
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Lahlou ND, Bakkali T, Zoulati M, Taoussi N, Benzakour Z, Lyazidi Y, Chtata H. [Tuberculosis aneurysm of descending thoracic aorta treated by covered stent graft : A case report]. Ann Cardiol Angeiol (Paris) 2023; 72:101614. [PMID: 37329821 DOI: 10.1016/j.ancard.2023.101614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/25/2023] [Accepted: 05/24/2023] [Indexed: 06/19/2023]
Abstract
Tuberculous aneurysm is a rare but lethal disease. It preferentially affects the aorta. The contamination occurs either secondarily to a tuberculosis site in contact with the aorta or by blood contamination. It presents an increased and unpredictable risk of rupture, hence the interest of urgent diagnostic and therapeutic management. His treatment was long based on surgery, but currently the endovascular approach is increasingly used. The treatment, whatever its type, will always be associated with a medical treatment for tuberculosis. We report the case of a patient with a descending thoracic aortic aneurysm considered tuberculous on the basis of epidemiological, clinical and biological arguments; who was treated by deployment of an endoprosthesis with good clinical and radiological evolution.
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Affiliation(s)
- Noured-Dine Lahlou
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay Riad, Rabat, Maroc.
| | - Tarik Bakkali
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay Riad, Rabat, Maroc
| | - Mohamed Zoulati
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay Riad, Rabat, Maroc
| | - Nizar Taoussi
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay Riad, Rabat, Maroc
| | - Zahra Benzakour
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay Riad, Rabat, Maroc
| | - Youssef Lyazidi
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay Riad, Rabat, Maroc
| | - Hassan Chtata
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay Riad, Rabat, Maroc
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Kadiyani L, Ramakrishnan S, Kumar S, Ramakrishnan P. Tubercular pseudoaneurysm of the axillary artery. Ann Pediatr Cardiol 2023; 16:363-366. [PMID: 38766448 PMCID: PMC11098286 DOI: 10.4103/apc.apc_156_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/07/2023] [Accepted: 12/13/2023] [Indexed: 05/22/2024] Open
Abstract
Tuberculous (TB) involvement of the vascular system has been reported in the preantibiotic era. We, hereby, report a case involving a teenage boy who presented to us with left upper limb pain followed by gradually progressive motor and sensory deficit over 1 month with preceding history of tuberculosis. Examination revealed a palpable, noncompressible, nonpulsatile swelling superior to the lateral third of the clavicle. Imaging through ultrasonography, computed tomography, and magnetic resonance imaging confirmed the presence of a pseudoaneurysm with compression of the underlying nerves. The child underwent surgical thrombectomy with pseudoaneurysm repair and arteriorrhaphy along with antitubercular medications with complete recovery at 6 months. The tissue staining, nucleic acid amplification tests, and histopathology confirmed TB etiology. Tuberculosis continues to remain a major health concern, especially in the developing world. High index of suspicion is necessary to diagnose such manifestations to avoid catastrophic sequelae.
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Affiliation(s)
- Lamk Kadiyani
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Sanjeev Kumar
- Department of Cardiac Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Pradeep Ramakrishnan
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
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Cardiovascular Involvement in Tuberculosis: From Pathophysiology to Diagnosis and Complications-A Narrative Review. Diagnostics (Basel) 2023; 13:diagnostics13030432. [PMID: 36766543 PMCID: PMC9914020 DOI: 10.3390/diagnostics13030432] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/18/2023] [Accepted: 01/23/2023] [Indexed: 01/27/2023] Open
Abstract
Although primarily a lung disease, extra-pulmonary tuberculosis (TB) can affect any organ or system. Of these, cardiovascular complications associated with disease or drug toxicity significantly worsen the prognosis. Approximately 60% of patients with TB have a cardiovascular disease, the most common associated pathological entities being pericarditis, myocarditis, and coronary artery disease. We searched the electronic databases PubMed, MEDLINE, and EMBASE for studies that evaluated the impact of TB on the cardiovascular system, from pathophysiological mechanisms to clinical and paraclinical diagnosis of cardiovascular involvement as well as the management of cardiotoxicity associated with antituberculosis medication. The occurrence of pericarditis in all its forms and the possibility of developing constrictive pericarditis, the association of concomitant myocarditis with severe systolic dysfunction and complication with acute heart failure phenomena, and the long-term development of aortic aneurysms with risk of complications, as well as drug-induced toxicity, pose complex additional problems in the management of patients with TB. In the era of multidisciplinarity and polymedication, evidence-based medicine provides various tools that facilitate an integrative management that allows early diagnosis and treatment of cardiac pathologies associated with TB.
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Adefuye MA, Manjunatha N, Ganduri V, Rajasekaran K, Duraiyarasan S, Adefuye BO. Tuberculosis and Cardiovascular Complications: An Overview. Cureus 2022; 14:e28268. [PMID: 36158349 PMCID: PMC9491794 DOI: 10.7759/cureus.28268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 11/25/2022] Open
Abstract
Tuberculosis (TB) is a dominant cause of mortality from a single infectious disease agent. It is a global health issue that has been tagged as a public health emergency for decades. The disease process, which is caused by Mycobacterium tuberculosis (MTB), affects the respiratory system as well as many other organ systems in the body, such as the lymphatic system, central nervous system (CNS), gastrointestinal system, and cardiovascular system (CVS). Generally, cardiovascular diseases are the leading cause of death worldwide, with most of the mortality in low and middle-income countries. Also, the high mortality rate of TB is skewed to these regions, making the mortality of TB with CVS involvement exceptionally high. The multisystemic involvement of TB impacts the cardiovascular system in various forms. While pericarditis caused by TB is quite common, other complications like myocarditis, coronary artery disease, and aortitis are rarer, necessitating a high index of suspicion and holistic management. This article reviews the pathophysiology of cardiovascular complications in TB, highlighting mechanisms of occurrence, common complications, management protocols, and prognostic factors. Our review highlights some of the gaps in understanding cardiovascular complications in TB, necessitating further research to investigate causal mechanisms and treatment.
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Chen Y, Sheng B, Li J, Lv F. Tuberculous Thoracic Aortic Pseudoaneurysm Associated With Spinal Tuberculosis: A Case Report and Literature Review. Front Med (Lausanne) 2022; 9:882697. [PMID: 35721076 PMCID: PMC9198831 DOI: 10.3389/fmed.2022.882697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background Thoracic aortic pseudoaneurysm associated with spinal tuberculosis is a rare but fatal condition. The risk of pseudoaneurysm rupture is extremely high and this disease needs greater awareness. The present study reported a case of thoracic aortic pseudoaneurysm caused by paravertebral cold abscess with spinal tuberculosis. Case presentation A 35-year-old woman with back pain was diagnosed with thoracic aortic pseudoaneurysm with spinal tuberculosis, and endovascular aneurysm repair (EVAR) was performed. The patient's symptoms disappeared after EVAR, following which she was discharged. Conclusions The case highlighted that in cases where non-enhanced computed tomography (CT) revealed that the aortic vessel was surrounded by a paravertebral abscess, magnetic resonance imaging (MRI) should be performed to confirm whether the presence of a pseudoaneurysm. Upon diagnosis of pseudoaneurysm, surgery should be performed immediately. In recent times, EVAR has emerged as a promising alternative to open surgery.
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Affiliation(s)
- Yurou Chen
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bo Sheng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jia Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Furong Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Yi S, Sheng L, Li W. Therapeutic effectiveness of tuberculous aneurysm and risk factors for mortality: a systematic review. Gen Thorac Cardiovasc Surg 2022; 70:515-525. [PMID: 35378674 PMCID: PMC9135858 DOI: 10.1007/s11748-022-01811-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 03/13/2022] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This study aimed to determine the therapeutic effectiveness of tuberculous aortic aneurysms (TBAAs) and the risk factors for mortality. METHODS We reviewed all case reports of TBAAs treated with open surgery or endovascular aneurysm repair (EVAR) from online database in 1996-2021. Only thoracic and abdominal aortic aneurysms were included. RESULTS Eighty cases of open surgery and 42 cases of EVAR were included. The 2-year mortality and perioperative mortality rates of open surgery were 11.3% and 10.0%, respectively. Emergent open surgery had a significantly higher mortality (25.0%) than non-emergent open surgery (6.7%). In the EVAR group, 2-year mortality, perioperative mortality, and TBAA-related mortality were 16.7%, 4.8%, and 10.0%, respectively. Patients with typical tuberculosis (TB) symptoms before EVAR had a significantly higher TBAA-related mortality (35.0%) than patients with no typical TB symptoms before EVAR (0%). In the open surgery group, the rate of TB recurrence (2.7% vs 2.4%) and aneurysm recurrence (8.1% vs 7.3%) were quite close between preoperative anti-TB-treated and postoperative anti-TB-treated cases. However, in the EVAR group, TB recurrence (8.7% vs 0%) and aneurysm recurrence (12.5% vs 6.25%) were more common in postoperative anti-TB-treated cases. CONCLUSION Open surgery was accompanied by higher perioperative mortality, whereas EVAR was followed with higher TBAA-related mortality. Emergent surgical choices of open surgery may be associated with high perioperative mortality. Typical TB symptoms before EVAR are a significant risk factor for mortality after EVAR. Early anti-TB treatment should be administered if EVAR is the surgical option.
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Affiliation(s)
- Shengwu Yi
- Zhejiang Hospital of Chinese Medicine, No. 54 Youdian Road, Hangzhou, Zhejiang, People's Republic of China
| | - Lingjie Sheng
- College of Health Science, Wuhan Sports University, No. 461 Luoyu Road, Wuhan, Hubei, People's Republic of China
| | - Wei Li
- Zhejiang Hospital of Chinese Medicine, No. 54 Youdian Road, Hangzhou, Zhejiang, People's Republic of China.
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Tran HV, Ho DK, Le VH, Van Duong H. Ruptured tuberculous aneurysms of the abdominal aorta: Two case series. Int J Surg Case Rep 2022; 92:106860. [PMID: 35231736 PMCID: PMC8886133 DOI: 10.1016/j.ijscr.2022.106860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background Ruptured aneurysms secondary to the tuberculous infection of the aorta are a rare and life-threatening disease. We report a single-center experience of two patients with ruptured infrarenal tuberculous aneurysms. Case presentation We report 2 patients with ruptures of the tuberculous aneurysm. All patients had acute abdominal pain and were diagnosed by echography then CT scan preoperatively. The first patient (male, 50 years old) had a ruptured saccular aneurysm. The second patient (male, 43 years old) had a retroperitoneal contained rupture. All were treated by open prosthetic repair, by vascular surgeons. The two patients were well after operations. The diagnosis was confirmed by pathology examination. Antituberculous treatment was introduced after the operation. Conclusions Ruptured tuberculous aneurysms are rare but life-threatening. The diagnosis requires a high degree of suspicion. The treatment includes early diagnosis and emergent surgical intervention, extensive excision of infected field, aortic reconstruction, and prolonged antituberculous drug therapy. The tuberculous aortic aneurysm is a fatal condition if not early diagnosed and properly treated. The diagnosis requires a high degree of suspicion. Surgery is necessary for stenotic or aneurysmal lesions. The treatment should be a combination of surgery and antituberculous medication.
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He H, Wang J, Li Q, Li X, Li M, Wang T, Li J, Wang L, Shu C. Endovascular repair combined with adjunctive procedures in the treatment of tuberculous infected native aortic aneurysms. J Vasc Surg 2022; 76:538-545.e2. [PMID: 35182661 DOI: 10.1016/j.jvs.2022.01.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/28/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The present study aimed to analyze the experience of a single center and assess the efficacy and durability of endovascular aortic repair (EVAR) in patients with tuberculous infected native aortic aneurysms (INAAs). METHODS All patients who underwent EVAR for INAAs between September 2014 and August 2021 were retrospectively reviewed. The primary endpoints were 30-day and overall mortality rates; the secondary outcomes included major complications, endoleak, recurrence, re-intervention rate, and thrombosis of the pseudoaneurysmal sac. RESULTS A total of 18 patients (average age 61.3 years; 10 female [55.6%]) were identified. Fifteen patients (83.3%) had adjunctive procedures in addition to EVAR. Both the in-hospital and 30-day mortality rates were 0%. The overall cumulative survival rates estimated by Kaplan-Meier were 100% at 1 and 6 months, and 92.3% at 12, 24, and 80.8% at 36 and 48 months. Type Ib and II endoleak each occurred in 1 (5.6%) patient and resolved without treatment after 1 month. No graft infections, strokes, paraplegia, ischemic abdominal complications, or other major complications occurred. The overall rates of cumulative freedom from recurrence of aneurysm and re-intervention were 83.9% and 81.8%, respectively, during the median follow-up period of 28.5 (1-72) months. The median time of administering anti-tuberculosis drugs was 10.5 (2-44) months. CONCLUSIONS EVAR combined with oral anti-tuberculosis medication is effective and may be an appealing treatment option for high risk INAAs patients. Adjunctive procedures, including targeted drug delivery to the site of infection, could be a solution to further controlling the infection but still needs further evaluation.
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Affiliation(s)
- Hao He
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China; The Institute of Vascular Diseases, Central South University, Changsha, China
| | - Junwei Wang
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China; The Institute of Vascular Diseases, Central South University, Changsha, China
| | - Quanming Li
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China; The Institute of Vascular Diseases, Central South University, Changsha, China
| | - Xin Li
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China; The Institute of Vascular Diseases, Central South University, Changsha, China
| | - Ming Li
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China; The Institute of Vascular Diseases, Central South University, Changsha, China
| | - Tun Wang
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China; The Institute of Vascular Diseases, Central South University, Changsha, China
| | - Jiehua Li
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China; The Institute of Vascular Diseases, Central South University, Changsha, China
| | - Lunchang Wang
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China; The Institute of Vascular Diseases, Central South University, Changsha, China
| | - Chang Shu
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China; The Institute of Vascular Diseases, Central South University, Changsha, China; Center of Vascular Surgery, State Key Laboratory of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
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Akabane K, Uchida T, Matsuo S, Hirooka S, Kim C, Uchino H, Shimanuki T. Hybrid operation for infectious thoracic and abdominal aortic aneurysms complicated with Bacillus Calmette-Guérin therapy for bladder cancer: A case report. Medicine (Baltimore) 2021; 100:e24796. [PMID: 33607839 PMCID: PMC7899839 DOI: 10.1097/md.0000000000024796] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/29/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONAL Bacillus Calmette-Guérin (BCG) intravesical instillation therapy is a widely used treatment for bladder cancer; however, an infectious aneurysm has been reported as a rare complication. PATIENT CONCERNS A 76-year-old man who underwent BCG intravesical instillation therapy for bladder cancer presented with prolonged dull back pain for 3 months. DIAGNOSIS Computed tomography (CT) revealed both thoracic and abdominal aortic aneurysms (AAAs). Follow-up CT at 4 weeks after the initial examination showed rapid enlargement of both aneurysms and typical findings of inflammation. Therefore, he was diagnosed with an impending rupture of infectious aneurysms. INTERVENTIONS Although open surgical resection of both aneurysms and vascular reconstruction were ideal, these operations were considered highly invasive for the patient. Therefore, a hybrid operation consisting of simultaneous endovascular repair of the thoracic aneurysm and open surgery of the abdominal lesion was performed. OUTCOMES BCG "Tokyo-172" strain was identified in the resected sample from the aneurysmal wall, and he continued to receive oral antituberculosis drugs for 6 months. No sign of recurrent infection was observed 1 year after the operation. LESSONS A hybrid operation might be justified as an alternative to the conventional open surgical procedure, especially for patients with infectious aneurysms caused by weak pathogenic bacteria such as, the BCG mycobacteria.
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MESH Headings
- Administration, Intravesical
- Aged
- Aneurysm, Infected/etiology
- Aneurysm, Infected/microbiology
- Aortic Aneurysm, Abdominal/diagnostic imaging
- Aortic Aneurysm, Abdominal/microbiology
- Aortic Aneurysm, Abdominal/surgery
- Aortic Aneurysm, Thoracic/diagnostic imaging
- Aortic Aneurysm, Thoracic/microbiology
- Aortic Aneurysm, Thoracic/surgery
- BCG Vaccine/administration & dosage
- BCG Vaccine/adverse effects
- Humans
- Male
- Mycobacterium/isolation & purification
- Tomography, X-Ray Computed
- Urinary Bladder Neoplasms/drug therapy
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Affiliation(s)
- Kentaro Akabane
- Division of Cardiovascular Surgery, Nihonkai General Hospital, Sakata
| | - Tetsuro Uchida
- Second Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Somei Matsuo
- Division of Cardiovascular Surgery, Nihonkai General Hospital, Sakata
| | - Shuto Hirooka
- Division of Cardiovascular Surgery, Nihonkai General Hospital, Sakata
| | - Cholus Kim
- Division of Cardiovascular Surgery, Nihonkai General Hospital, Sakata
| | - Hideaki Uchino
- Division of Cardiovascular Surgery, Nihonkai General Hospital, Sakata
| | - Takao Shimanuki
- Division of Cardiovascular Surgery, Nihonkai General Hospital, Sakata
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Abstract
ABSTRACT Mycobacterium infection remains a leading cause of morbidity and mortality worldwide. Although rare, thoracic cardiovascular complications are associated with devastating consequences if not promptly diagnosed using computed tomography. Intrapulmonary complications include tuberculous aortitis, Rasmussen aneurysms, involvement of bronchial and nonbronchial systemic arteries, and thromboembolic events. Extrapulmonary complications include pericarditis, myocarditis, endocarditis, involvement of coronary arteries, annular-subvalvular left ventricle aneurysms and mediastinal fibrosis. This article will review these complications and their computed tomography features.
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12
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Vijayvergiya R, Kasinadhuni G, Revaiah PC, Lal A, Sharma A, Kumar R. Thoracic endovascular aortic repair for aortobronchial fistula: a case series. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-6. [PMID: 34109286 PMCID: PMC8183659 DOI: 10.1093/ehjcr/ytaa265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 04/14/2020] [Accepted: 07/16/2020] [Indexed: 11/14/2022]
Abstract
Background Aortobronchial fistula (ABF) formation following the rupture of thoracic pseudoaneurysm is a rare clinical entity. Its aetiology includes atherosclerosis, infections, trauma, post-surgery, and post-endovascular aortic repair. The clinical presentation of ABF includes intermittent or massive haemoptysis, acute respiratory distress, hypotension, and even death. These patients require an emergency aortic intervention to stop active haemorrhage. Thoracic endovascular aortic repair (TEVAR) is a less invasive, safe, and effective treatment compared to conventional open surgical repair Case summary We hereby report three cases of ruptured descending thoracic aortic pseudoaneurysms resulting in a fistula formation. The first two cases had tuberculosis as their underlying aetiology, while the third case was the result of previous open post-aortic surgery. All patients presented with massive haemoptysis and were successfully treated by emergency TEVAR and had favourable outcomes. Discussion Thoracic endovascular aortic repair is a rapid, less invasive, and effective treatment for emergency management of ABF. It has more than 85% technical success rates in the reported literature. We had procedural success in all three cases. The short and midterm outcome of ABF following TEVAR is favourable and encouraging.
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Affiliation(s)
- Rajesh Vijayvergiya
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh 160012, India
| | - Ganesh Kasinadhuni
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh 160012, India
| | - Pruthvi C Revaiah
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh 160012, India
| | - Anupam Lal
- Department of Radio Diagnosis, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh 160012, India
| | - Ashish Sharma
- Department of Vascular Surgery, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh 160012, India
| | - Rupesh Kumar
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh 160012, India
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Elzein F, Qatan N, Alghamdi A, Albarrak A, Kalam K. Miliary tuberculosis presenting as bilateral superficial femoral artery mycotic aneurysm in an immunocompetent patient. Respir Med Case Rep 2019; 26:236-239. [PMID: 30775239 PMCID: PMC6365391 DOI: 10.1016/j.rmcr.2019.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 01/22/2019] [Accepted: 01/22/2019] [Indexed: 11/25/2022] Open
Abstract
Mycotic tuberculous aneurysm is extremely rare. The aorta is the main affected artery however; iliac and less commonly femoral arteries can also be affected. In 75% of the cases a contagious focus leads to infection through erosion of the vessel wall; on the other hand direct seeding of the blood vessel wall via the vasa vasorum may occur in 25%. In a large number of patients it may be a manifestation of miliary tuberculosis. In this case report we describe an immunocompetent patient who presented with bilateral superficial femoral artery aneurysms, followed by bilateral testicular swellings and inferior mesenteric artery aneurysm, as a presentation of military tuberculosis. Early diagnosis of such patients is essential for initiation of both medical and surgical treatment in order to avoid catastrophic outcome of rupture and bleeding.
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Affiliation(s)
- Fatehi Elzein
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - Nabeel Qatan
- Vascular Surgery Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - Abdullah Alghamdi
- Urology Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - Ali Albarrak
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - Kiran Kalam
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
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14
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Ikeda S, Shih M, Likourezos A, Flom P, Rhee RY, Youdelman BA. The treatment of tuberculous aortic pseudoaneurysm. J Card Surg 2018; 33:840-852. [DOI: 10.1111/jocs.13952] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Shinichiro Ikeda
- Department of Surgery, Division of Cardiothoracic Surgery; Maimonides Medical Center; Brooklyn New York
| | - Michael Shih
- Department of Surgery, Division of Vascular Surgery; Maimonides Medical Center; Brooklyn New York
| | - Antonios Likourezos
- Department of Emergency Medicine, Research manager/Statistical Analysis Consultant; Maimonides Medical Center; Brooklyn New York
| | - Peter Flom
- Peter Flom Consulting; New York New York
| | - Robert Y. Rhee
- Department of Surgery, Division of Vascular Surgery; Maimonides Medical Center; Brooklyn New York
| | - Benjamin A. Youdelman
- Department of Surgery, Division of Cardiothoracic Surgery; Maimonides Medical Center; Brooklyn New York
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15
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Xue J, Yao Y, Liu L. Treatment of tuberculous aortic pseudoaneurysm associated with vertebral tuberculosis: A case series and a literature review. Medicine (Baltimore) 2018; 97:e0382. [PMID: 29642195 PMCID: PMC5908578 DOI: 10.1097/md.0000000000010382] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Tuberculous aortic pseudoaneurysm associated with vertebral tuberculosis is a rare disease but with very high mortality. We review the literature and find 19 reports with 22 patients. Here we report three cases with vertebral tuberculosis, who also have tuberculous pseudoaneurysm of the aorta. These patients were treated by different methods. We try to analyze the epidemiology, pathogenesis, presentation, and management of this disease to find the best treatment. PATIENT CONCERNS The patients presented with different symptoms such as pain (chest, abdominal or back), fever, blood volume reduction or hemorrhagic shock symptoms. Large mass also could be observed by imaging. In addition to clinical manifestations, enhanced computed tomography or magnetic resonance imaging could also help the diagnosis of this disease. DIAGNOSES Tuberculous aortic pseudoaneurysm associated with vertebral tuberculosis. INTERVENTIONS Three patients were treated with anti-tuberculosis(TB) drugs or combined with different sequences surgical treatment: Case 1 refused to receive pseudoaneurysm surgery and only had anti-TB drug treatment; Case 2 received thoracic spinal surgery first; Case 3 received endovascular stent grafting. OUTCOMES Two patients (case 1 and case 2) who refused to undergo aneurysm surgery died. The last patient (case 3) underwent endovascular repair and antibiotic therapy for tuberculosis, and the postoperative course was uneventful; the patient recovered and survived. LESSONS Once the diagnosis of tuberculous pseudoaneurysm is confirmed, surgical treatment should be provided immediately combined with anti-tuberculosis drugs. The aim of the treatment is to save lives, prevent relapse, and facilitate the return to normal life, regardless of the size of the pseudoaneurysm. The pseudoaneurysm should be treated first to prevent aneurysm rupture before the vertebral tuberculosis surgery.
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MESH Headings
- Adult
- Aneurysm, False/diagnosis
- Aneurysm, False/etiology
- Aneurysm, False/physiopathology
- Aneurysm, False/surgery
- Antitubercular Agents/therapeutic use
- Aortitis/diagnosis
- Aortitis/etiology
- Aortitis/therapy
- Combined Modality Therapy/methods
- Female
- Humans
- Magnetic Resonance Imaging/methods
- Male
- Middle Aged
- Spinal Fusion/methods
- Thoracic Vertebrae/microbiology
- Thoracic Vertebrae/pathology
- Tomography, X-Ray Computed/methods
- Treatment Outcome
- Tuberculosis, Cardiovascular/complications
- Tuberculosis, Cardiovascular/diagnosis
- Tuberculosis, Spinal/diagnosis
- Tuberculosis, Spinal/drug therapy
- Tuberculosis, Spinal/physiopathology
- Tuberculosis, Spinal/surgery
- Vascular Surgical Procedures/methods
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Affiliation(s)
- Jing Xue
- Department of Orthopaedics, West China Hospital, Sichuan University
| | - Yimin Yao
- Department of Orthopaedics, PLA 452th Hospital, Chengdu, China
| | - Limin Liu
- Department of Orthopaedics, West China Hospital, Sichuan University
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16
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Kasangana K, Shih M, Saunders P, Rhee R. Common carotid artery pseudoaneurysm secondary to Mycobacterium tuberculosis treated with resection and reconstruction with saphenous vein graft. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2018; 3:192-195. [PMID: 29349420 PMCID: PMC5764893 DOI: 10.1016/j.jvscit.2017.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 06/14/2017] [Indexed: 11/28/2022]
Abstract
Extracranial carotid artery aneurysms secondary to Mycobacterium tuberculosis infection are exceedingly rare. Despite an uncommon location and offending pathogen, the treatment paradigm follows that of all mycotic aneurysms. We report the case of a right common carotid artery pseudoaneurysm caused by a tuberculous infection, successfully treated with antibiotics, resection, and autologous interposition graft.
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Affiliation(s)
- Kalenda Kasangana
- Division of Vascular and Endovascular Surgery, Maimonides Medical Center, Brooklyn, NY
| | - Michael Shih
- Division of Vascular and Endovascular Surgery, Maimonides Medical Center, Brooklyn, NY
| | - Paul Saunders
- Division of Cardiothoracic Surgery, Maimonides Medical Center, Brooklyn, NY
| | - Robert Rhee
- Division of Vascular and Endovascular Surgery, Maimonides Medical Center, Brooklyn, NY
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17
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Manika K, Efthymiou C, Damianidis G, Zioga E, Papadaki E, Lagoudi K, Kioumis I. Miliary tuberculosis in a patient with tuberculous mycotic aneurysm of the abdominal aorta: Case report and review of the literature. Respir Med Case Rep 2017; 21:30-35. [PMID: 28377878 PMCID: PMC5369367 DOI: 10.1016/j.rmcr.2017.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/13/2017] [Accepted: 03/19/2017] [Indexed: 11/08/2022] Open
Abstract
The combination of miliary tuberculosis and tuberculous mycotic aneurysm has been described in the literature. We present the case of an 84-year-old man who was diagnosed with a mycotic aneurysm of the abdominal aorta and an adjacent soft tissue mass, after a 3- month history of fever. The patient underwent endovascular restoration of the aneurysm and was treated with broad-spectrum antibiotics. One and a half months later the fever relapsed and the chest CT scan revealed findings consistent with miliary tuberculosis and opacities of both upper lobes not present before, while the abdominal CT scan revealed an increase in the size of the para-aortic mass. Tuberculosis was documented by positive culture for M. tuberculosis of bronchial washing and by the CT-guided para-aortic mass biopsy. The patient received anti-TB treatment for 9 months leading to a spectacular improvement of his clinical condition and imaging findings. A review of the literature since 2008 revealed 28 more cases of tuberculous mycotic aneurysm. The treatment and outcome of all cases are described. Mycotic aneurysm of tuberculous etiology remains a reality and has a relatively good prognosis. Although miliary tuberculosis affects mortality even elderly patients may benefit from "aggressive" management and treatment.
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Affiliation(s)
- Katerina Manika
- Respiratory Infections Unit, Pulmonary Department, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Greece
| | - Christoforos Efthymiou
- Respiratory Infections Unit, Pulmonary Department, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Greece
| | - Georgios Damianidis
- 1st Internal Medicine Department, Ippokrateion General Hospital, Thessaloniki, Greece
| | - Elisavet Zioga
- 1st Internal Medicine Department, Ippokrateion General Hospital, Thessaloniki, Greece
| | - Eleni Papadaki
- Respiratory Infections Unit, Pulmonary Department, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Greece
| | - Kalliopi Lagoudi
- Respiratory Infections Unit, Pulmonary Department, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Greece
| | - Ioannis Kioumis
- Respiratory Infections Unit, Pulmonary Department, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Greece
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18
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Manuel V, Tiago J, Martins P, Martins C, Nunes JS, Fernandes e Fernandes J. Tuberculous aortitis, a case report. ANGIOLOGIA E CIRURGIA VASCULAR 2016. [DOI: 10.1016/j.ancv.2015.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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19
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Im KS, Choi MK, Jeon YK, Lee JM. Dissecting thoracic aortic aneurysm associated with tuberculous pleural effusion. J Thorac Dis 2016; 8:E520-2. [PMID: 27499987 DOI: 10.21037/jtd.2016.05.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We present the case of thoracic aortic aneurysm associated with the tuberculous pleural effusion. An 82-year-old woman underwent emergency stent graft under a diagnosis of dissecting thoracic aortic aneurysm. Preoperative computed tomography revealed right pleural effusion supposed to the hemothorax caused by the dissecting aneurysm. But, the effusion was sanguineous color fluid and it was determined to result from pulmonary tuberculosis. The medical team was exposed to the pulmonary tuberculosis; fortunately no one became infected. Physicians should be aware of the possibility of an infected aortic aneurysm and prepare for pathogen transmission.
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Affiliation(s)
- Kyong Shil Im
- Department of Anesthesiology and Pain Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min Kyung Choi
- Department of Anesthesiology and Pain Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong Kyoung Jeon
- Department of Anesthesiology and Pain Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Myeong Lee
- Department of Anesthesiology and Pain Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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20
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Kouchoukos NT. Tuberculous aneurysm of the aorta: Rare but treatable. J Thorac Cardiovasc Surg 2016; 152:e98-9. [PMID: 27449356 DOI: 10.1016/j.jtcvs.2016.06.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 06/22/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Nicholas T Kouchoukos
- Division of Cardiovascular and Thoracic Surgery, Missouri Baptist Medical Center, BJC HealthCare, St Louis, Mo.
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21
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Tijani Y, Ghannam A, Elfatemi B, Elkharroubi A, Hormat-Allah M, Elidrissi R, Elkhloufi S, Sefiani Y, Lekehal B, Elmesnaoui A, Ammar F, Bensaid Y. [The aneurysms of the aorta of tuberculous]. Ann Cardiol Angeiol (Paris) 2016; 65:107-110. [PMID: 26656506 DOI: 10.1016/j.ancard.2015.09.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 09/03/2015] [Indexed: 06/05/2023]
Abstract
Tuberculosis is a public health problem in Morocco, which is difficult to eradicate despite the recognized efficiency of health policies. Aortic aneurysm is rare and lethal complication of spontaneous evolution. Pathophysiological characteristics and the difficulty of early diagnosis worsen the prognosis.
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Affiliation(s)
- Y Tijani
- Service de chirurgie vasculaire, université Mohammed V, CHU Ibn Sina, Souissi Rabat, Maroc.
| | - A Ghannam
- Service d'anesthésie réanimation, université Mohammed V, CHU Ibn Sina, Souissi Rabat, Maroc
| | - B Elfatemi
- Service de chirurgie vasculaire, université Mohammed V, CHU Ibn Sina, Souissi Rabat, Maroc
| | - A Elkharroubi
- Service de chirurgie vasculaire, université Mohammed V, CHU Ibn Sina, Souissi Rabat, Maroc
| | - M Hormat-Allah
- Service de chirurgie vasculaire, université Mohammed V, CHU Ibn Sina, Souissi Rabat, Maroc
| | - R Elidrissi
- Service de chirurgie vasculaire, université Mohammed V, CHU Ibn Sina, Souissi Rabat, Maroc
| | - S Elkhloufi
- Service de chirurgie vasculaire, université Mohammed V, CHU Ibn Sina, Souissi Rabat, Maroc
| | - Y Sefiani
- Service de chirurgie vasculaire, université Mohammed V, CHU Ibn Sina, Souissi Rabat, Maroc
| | - B Lekehal
- Service de chirurgie vasculaire, université Mohammed V, CHU Ibn Sina, Souissi Rabat, Maroc
| | - A Elmesnaoui
- Service de chirurgie vasculaire, université Mohammed V, CHU Ibn Sina, Souissi Rabat, Maroc
| | - F Ammar
- Service de chirurgie vasculaire, université Mohammed V, CHU Ibn Sina, Souissi Rabat, Maroc
| | - Y Bensaid
- Service de chirurgie vasculaire, université Mohammed V, CHU Ibn Sina, Souissi Rabat, Maroc
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22
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Hung YM, Chang YT, Wang JS, Wang PYP, Wann SR. A rare but potentially lethal case of tuberculous aortic aneurysm presenting with repeated attacks of abdominal pain. Intern Med 2015; 54:1145-8. [PMID: 25948366 DOI: 10.2169/internalmedicine.54.3620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Tuberculous aortic aneurysm is an extremely rare disease with a high mortality rate. The clinical features of this condition are highly variable, ranging from asymptomatic with or without constitutional symptoms, abdominal pain to frank rupture, bleeding and shock. We herein report the case of a 56-year-old man with a large tuberculous mycotic aneurysm in the abdominal aorta with an initial presentation of repeated attacks of abdominal pain lasting for several months. Due to the vague nature of the initial symptoms, tuberculous aortic aneurysms may take several months to diagnose. This case highlights the importance of having a high index of suspicion and providing timely surgery for this rare but potentially lethal disease.
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MESH Headings
- Abdominal Pain/etiology
- Abdominal Pain/microbiology
- Abdominal Pain/therapy
- Aneurysm, Infected/diagnosis
- Aneurysm, Infected/microbiology
- Aneurysm, Infected/therapy
- Antibiotics, Antitubercular/administration & dosage
- Aorta, Abdominal/microbiology
- Aorta, Abdominal/pathology
- Aortic Aneurysm, Abdominal/diagnosis
- Aortic Aneurysm, Abdominal/microbiology
- Aortic Aneurysm, Abdominal/therapy
- Follow-Up Studies
- Humans
- Male
- Middle Aged
- Tomography, X-Ray Computed
- Treatment Outcome
- Tuberculosis, Cardiovascular/complications
- Tuberculosis, Cardiovascular/diagnosis
- Tuberculosis, Cardiovascular/microbiology
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Affiliation(s)
- Yao-Min Hung
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, 2) Yuhing Junior College of Health Care and Management, Taiwan
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23
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Kumar P, Zhang J, Miller S, Wilton G. Yersinia enterocolitica: a rare cause of infected aortic aneurysm successfully treated with antibiotics and endovascular repair. JMM Case Rep 2014. [DOI: 10.1099/jmmcr.0.002626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - John Zhang
- Timaru Hospital, South Canterbury, 7910, New Zealand
| | - Sarah Miller
- Timaru Hospital, South Canterbury, 7910, New Zealand
| | - Gavin Wilton
- Timaru Hospital, South Canterbury, 7910, New Zealand
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24
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Nakayama Y, Yamaki F, Matsumura Y. Endovascular aneurysm repair of saccular descending thoracic pseudoaneurysm possibly associated with tuberculosis. Gen Thorac Cardiovasc Surg 2012; 60:501-3. [PMID: 22700454 DOI: 10.1007/s11748-012-0038-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Accepted: 09/05/2011] [Indexed: 11/26/2022]
Abstract
In 2010, an 84-year-old man underwent thoracic endovascular aneurysm repair (TEVAR) for the saccular descending thoracic pseudoaneurysm (DTAA), which was adherent to the pulmonary lobe and thoracic vertebrae. Past medical history comprised twice anti-tuberculous medications for pulmonary tuberculosis and tuberculous vertebral osteomyelitis. The dilated aorta was detected at the time of medication for tuberculous vertebral osteomyelitis 24 years ago. However, he was not indicated for the operation, and he was lost to follow-up until now. The association of tuberculosis bacilli was suspected through clinical course as an origin of DTAA, although the histopathological examination was not performed because of invasion. TEVAR was performed considering: (1) no preoperative ongoing inflammation, (2) no evidence of tuberculosis recurrence, and (3) risk factors, such as pulmonary impairments and high age. Several months have been passed since the operation, and the patient remains well without perioperative anti-tuberculous medications.
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MESH Headings
- Aged, 80 and over
- Aneurysm, False/diagnosis
- Aneurysm, False/drug therapy
- Aneurysm, False/microbiology
- Aneurysm, False/surgery
- Aneurysm, Infected/diagnosis
- Aneurysm, Infected/drug therapy
- Aneurysm, Infected/microbiology
- Aneurysm, Infected/surgery
- Antitubercular Agents/therapeutic use
- Aortic Aneurysm, Thoracic/diagnosis
- Aortic Aneurysm, Thoracic/drug therapy
- Aortic Aneurysm, Thoracic/microbiology
- Aortic Aneurysm, Thoracic/surgery
- Aortography/methods
- Blood Vessel Prosthesis Implantation
- Endovascular Procedures
- Humans
- Male
- Tomography, X-Ray Computed
- Treatment Outcome
- Tuberculosis, Cardiovascular/diagnosis
- Tuberculosis, Cardiovascular/drug therapy
- Tuberculosis, Cardiovascular/microbiology
- Tuberculosis, Cardiovascular/surgery
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Affiliation(s)
- Yuki Nakayama
- Department of Cardiovascular Surgery, Nagano Chuo Hospital, Nishitsuruga, Nagano, Nagano, Japan.
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25
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Endovascular Treatment of an Aortoiliac Tuberculous Pseudoaneurysm. Cardiovasc Intervent Radiol 2012; 36:540-4. [DOI: 10.1007/s00270-012-0398-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Accepted: 04/10/2012] [Indexed: 10/28/2022]
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26
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Archer RM, Gordon SJG, Carslake HB, Collett MG. Distal aortic aneurysm presumed to be secondary to an infected umbilical artery in a foal. N Z Vet J 2011; 60:65-8. [PMID: 22175433 DOI: 10.1080/00480169.2011.620546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
CASE HISTORY A 3-month-old female Warmblood foal was presented after displaying signs of colic with pyrexia for 5 days. CLINICAL AND PATHOLOGICAL FINDINGS The foal continued to show signs of colic, frequently passed urine, and was pyrexic with an elevated white blood cell count. The umbilical stalk was thickened but there was no evidence of purulent material. Exploratory laparotomy revealed an enlarged left umbilical artery remnant tightly adhered to the bladder wall. The left umbilical artery continued to an aneurysm involving the distal aorta. The foal was subject to euthanasia and post-mortem examination confirmed a spherical aortic aneurysm, in the dorsal midline caudal to the kidneys that contained a large thrombus. Histopathological examination revealed inflammation and necrosis of the tunica intima and tunica media of the left umbilical artery with suppuration and bacterial colonies evident in the periarterial tissues. DIAGNOSIS Infected aortic aneurysm presumably caused by an umbilical artery infection. CLINICAL RELEVANCE A previously undetected umbilical infection appears to have resulted in an unusual delayed complication causing signs of colic in a foal. Veterinarians should be aware of this condition, and the possibility that it may be a cause of signs of colic in foals. Diagnosis based on ultrasonography should be possible, but may require sedation, visceral analgesia and careful examination.
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Affiliation(s)
- R M Archer
- Massey University Veterinary Teaching Hospital, Institute of Veterinary, Animal and Biomedical Sciences, Massey University, Private Bag 11222, Palmerston North 4442, New Zealand.
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27
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Li FP, Wang XF, Xiao YB. Endovascular Stent Graft Placement in the Treatment of a Ruptured Tuberculous Pseudoaneurysm of the Descending Thoracic Aorta Secondary to Pott's Disease of the Spine. J Card Surg 2011; 27:75-7. [DOI: 10.1111/j.1540-8191.2011.01343.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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28
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Han DK, Chung C, Walkup MH, Faries PL, Marin ML, Ellozy SH. Endovascular stent-graft repair of a tuberculous mycotic aortic aneurysm. Ann Vasc Surg 2011; 25:699.e13-6. [PMID: 21514110 DOI: 10.1016/j.avsg.2010.12.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Revised: 11/05/2010] [Accepted: 12/24/2010] [Indexed: 11/19/2022]
Abstract
Mycobacterium tuberculosis is a rare cause of mycotic aortic aneurysms, which have been classically treated with a combination of antimycobacterial medical therapy and open surgery. Endovascular therapy has been gaining popularity as an alternative to open surgery for mycotic aneurysms. We report a case of a tuberculous mycotic aneurysm of the descending thoracic aorta that was successfully treated with endovascular stent-graft placement with complete resolution of the pseudoaneurysm at 1 year. We also review other cases in the previously published data to identify factors that may affect the outcome of endovascular treatment of tuberculous mycotic aneurysms.
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MESH Headings
- Aneurysm, False/diagnostic imaging
- Aneurysm, False/microbiology
- Aneurysm, False/surgery
- Aneurysm, Infected/diagnostic imaging
- Aneurysm, Infected/microbiology
- Aneurysm, Infected/surgery
- Antitubercular Agents/therapeutic use
- Aortic Aneurysm, Thoracic/diagnostic imaging
- Aortic Aneurysm, Thoracic/microbiology
- Aortic Aneurysm, Thoracic/surgery
- Aortography/methods
- Blood Vessel Prosthesis
- Blood Vessel Prosthesis Implantation/instrumentation
- Endovascular Procedures/instrumentation
- Female
- Humans
- Middle Aged
- Mycobacterium tuberculosis/isolation & purification
- Stents
- Tomography, X-Ray Computed
- Treatment Outcome
- Tuberculosis, Cardiovascular/microbiology
- Tuberculosis, Cardiovascular/surgery
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Affiliation(s)
- Daniel K Han
- Division of Vascular Surgery, Department of Surgery, Mount Sinai School of Medicine, New York, NY, USA.
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29
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Endovascular repair of a tuberculous mycotic thoracic aortic aneurysm with a custom-made device. J Vasc Surg 2010; 51:1272-5. [DOI: 10.1016/j.jvs.2009.12.047] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Revised: 12/14/2009] [Accepted: 12/15/2009] [Indexed: 11/19/2022]
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30
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Lefranc M, Peltier J, Bidaud M, Reix T. Anévrisme tuberculeux de l’aorte abdominale : cas clinique et revue de la littérature. Rev Med Interne 2009; 30:625-7. [DOI: 10.1016/j.revmed.2008.08.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2007] [Revised: 05/29/2008] [Accepted: 08/08/2008] [Indexed: 11/16/2022]
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31
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Endovascular Stent Graft Placement in the Treatment of Ruptured Tuberculous Pseudoaneurysm of the Descending Thoracic Aorta: Case Report and Review of the Literature. Cardiovasc Intervent Radiol 2008; 32:572-6. [DOI: 10.1007/s00270-008-9456-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Revised: 08/28/2008] [Accepted: 09/03/2008] [Indexed: 10/21/2022]
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32
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Tuberculous aneurysms of the abdominal aorta. J Vasc Surg 2008; 48:1012-6. [DOI: 10.1016/j.jvs.2008.05.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Revised: 04/24/2008] [Accepted: 05/04/2008] [Indexed: 11/18/2022]
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33
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Clerc O, Jaton K, Prod'hom G, Von Segesser L, Greloz V, Greub G. Mycobacterium tuberculosis aortic graft infection with recurrent hemoptysis: a case report. J Med Case Rep 2008; 2:233. [PMID: 18634553 PMCID: PMC2491651 DOI: 10.1186/1752-1947-2-233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Accepted: 07/18/2008] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Mycobacterium tuberculosis may cause a large variety of clinical presentations due to its ability to disseminate by contiguity or hematogenously. Tuberculosis may remain undiagnosed for years due to the chronic course of the disease, with potentially life-threatening long-term complications. CASE PRESENTATION In this case report, we describe a tuberculous aortic graft infection in a 72-year-old man documented by polymerase chain reaction and cultures. The patient presented with three episodes of hemoptysis following a remote history of miliary tuberculosis. The infection was treated by graft replacement and prolonged antimycobacterial therapy. CONCLUSION Tuberculous infection of a vascular graft is an uncommon complication, but should be considered in patients with an intravascular device and a history of previous tuberculosis, especially when hematogenous spread may have occurred a few months after surgery, or when an active mycobacterial infection is present in close proximity to the graft.
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Affiliation(s)
- Olivier Clerc
- Infectious Diseases Service, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland
| | - Katia Jaton
- Institute of Microbiology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland
| | - Guy Prod'hom
- Institute of Microbiology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland
| | - Ludwig Von Segesser
- Cardiovascular Surgery Department, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland
| | - Vincent Greloz
- Pathology Department, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland
| | - Gilbert Greub
- Infectious Diseases Service, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland
- Institute of Microbiology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland
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