[Tuberculous mycotic aneurism of the aorta: a case report of haemoptysis.]

Mycotic aneurysm secondary to tuberculous infection (TB) of the aorta is a rare and life-threatening disease. We report a case report of a 78-year-old woman with a tuberculous mycotic aortic aneurysm (TBAA). Early diagnosis and a combination of surgical intervention (aortic reconstruction and extensive excision of the infected field) and prolonged antituberculous drug therapy provide long-term survival without evidence of recurrence after tuberculous aortic involvement.

Tuberculous Aneurysm of the Supraceliac Aorta

Significant vascular complications are rare following systemic infections with Mycobacterium tuberculosis (TB). This report describes a 33-year-old man who presented with a short history of abdominal discomfort and febrile episodes with no prior history of infection with TB. Ultrasound, CT scan, and aortography confirmed the presence of a pseudoaneurysm originating from the posterior aspect of the supraceliac aorta at the level of the diaphragm. Via a full thoracoabdominal approach, periaortic inflammatory tissue and the aortic wall itself were debrided, and repair of the pseudoaneurysm was achieved with a synthetic patch. Mycobacterium tuberculosis was isolated from the aortic wall, and anti-TB medications were instituted. Postoperatively the patient did well and was discharged after 14 days. As illustrated by this case, tuberculous mycotic aneurysms of the aorta are optimally treated with a combination of medical and surgical therapy, and early diagnosis is essential to ensure survival.

Tuberculous iliac artery aneurysm in a pediatric patient

Vascular complications of tuberculous infections are rare and occur even less frequently in the pediatric population. Tuberculous pseudoaneurysms can occur either as a result of contiguous spread from a neighboring focus-invariably infected lymph nodes-or by hematogenous spread and seeding of acid-fast bacilli that lodge in the adventitia or media via the vasa vasorum. We report a case of turberculous right common iliac artery pseudoaneurysm in a 12-year-old and review the relevant literature.

It's aneurysmal, it's stenotic, it's tuberculosis

Tuberculous vasculitis is a very rare presentation of tuberculosis. So far this is the second reported case in the literature. The diagnosis of this disorder is based on the clinical presentation as well as blood investigation results. With the ever improvement in modern medicine and improvement in endovascular treatment of such diseases, the morbidity and mortality of these patients have been dramatically reduced with better clinical and survival results. We present a case of endovascular stenting of a stenotic subclavian artery with good results.

Endovascular treatment of a tuberculous infected aneurysm of the descending thoracic aorta: A word of caution

An infected aneurysm of the thoracic aorta due to mycobacterium tuberculosis is an unusual entity for which the classical treatment is antituberculosis chemotherapy and open-chest surgery. Recent improvements in endovascular treatments have led to their proposed use for infected aneurysms in patients for whom open surgery poses too high a risk. We report on a 68-year-old man with a tuberculous aortic aneurysm who had been treated with an endoprosthesis and antituberculosis chemotherapy. His clinical and radiological follow-up was uneventful and led to the discontinuation of pharmacological treatment after 16 months. However, a recurrence of the infection led to a fatal aortic rupture 4 months after discontinuation of therapy.

Ruptured mycotic abdominal aortic aneurysm secondary to Mycobacterium bovis after intravesical treatment with bacillus Calmette-Guérin

Bacillus Calmette-Guérin (BCG) is a live attenuated strain of Mycobacterium bovis that has proven effective in the treatment of early-stage bladder cancer. Although intravesical therapy with BCG is generally considered safe, serious complications including hematuria, granulomatous pneumonitis, hepatitis, and life-threatening BCG sepsis are well known. BCG-related vascular infections are rarely reported. We present a case of a ruptured abdominal aortic aneurysm secondary to M bovis infection 2 years after intravesical instillation of BCG and review the related literature.

Tuberculous pericardial effusion after coronary artery bypass graft

We describe a case of a recurrent pericardial effusion after coronary artery bypass grafting. This was initially considered to be due to post-pericardiotomy syndrome, but was later treated empirically as tuberculosis. After definitive surgery for this condition, pericardial histology and immunohistochemistry confirmed the diagnosis of tubercular pericarditis. At 4-months follow-up, while continuing anti-tuberculous therapy and corticosteroids, the patient showed consistent improvement without further recurrence of his pericardial effusion. Local reactivation of tuberculosis after pericardiotomy has not been previously reported and merits careful consideration in population groups in which tuberculosis is highly endemic.

Aortobifemoral graft infection with mycobacterium tuberculosis: Treatment with abscess drainage, debridement, and long-term administration of antibiotic agents

Aortic graft infection with Mycobacterium tuberculosis is rare. We report a patient with a Dacron aortobifemoral prosthetic graft infection secondary to tuberculosis. The infection was successfully treated with surgical drainage without removal of the graft, and long-term antimycobacterial medications. A review of the literature contains only 1 other report of tuberculosis graft infection and treatment. We discuss a rare form of aortic graft infection from M tuberculosis and its treatment.

Tuberculous pseudoaneurysm of the descending thoracic aorta: successful treatment by surgical excision and primary repair

Tuberculous pseudoaneurysm of the aorta is a rare disease with a high mortality rate. We present the case of a 27-year-old woman who had a tuberculous pseudoaneurysm of the descending thoracic aorta. The patient underwent successful excision and primary repair of the lesion while under hypothermic circulatory arrest and partial femoral bypass. To the best of our knowledge, this is the youngest patient to be successfully treated with surgery for a tuberculous pseudoaneurysm of the descending thoracic aorta. The pathogenesis, diagnosis, and treatment of this disease are reviewed, and the need to include tuberculous pseudoaneurysm in the differential diagnosis of chest lesions is emphasized.

Tuberculous mycotic aneurysm of the aorta: review of published medical and surgical experience

To define the epidemiology, pathogenesis, pathology, presentation, and management of tuberculous mycotic aneurysm of the aorta (TBAA) in the therapeutic era, we reviewed all of the cases reported in the English language literature from 1945 to the present. To the 39 cases in the published literature, we add two cases of our own. Although it is exceedingly rare, the prevalence of this lesion has remained relatively constant. In 75% of the cases, TBAA appeared to result from erosion of the aortic wall by a contiguous focus; 25% from direct seeding of the aortic intima or of the adventitia or media (via the vasa vasorum). Most of the aneurysms were saccular (90%) and false (88%). The thoracic and abdominal aortas were affected with equal frequency. The mean (+/- SD) age of the patients was 50+/-16 years. Twenty-two were men, and 19 were women. In 63% of the cases, tuberculosis (TB) was diagnosed at presentation. Disseminated TB was present in 46% of the cases. One or more of three clinical scenarios suggested TBAA: persistent pain, major bleeding, and a palpable or radiographically visible para-aortic mass, especially if it is expanding or pulsatile. In turn, each of these findings suggested a complication of TBAA that may be an indication for surgical intervention. Among the patients who were offered both medical and surgical treatment, 20 of 23 (87%) survived. Among those who were offered only one form of treatment or were offered no treatment at all there were no survivors. Both in situ reconstruction with a prosthetic graft, and extra-anatomic bypass appeared to offer excellent results, provided that an effective regimen of antituberculous drugs was delivered postoperatively. We offer our conclusions: (1) symptomatic TBAA is a rare but uniformly fatal lesion if not diagnosed promptly, (2) in the context of active TB, and especially miliary TB, TBAA should be suspected whenever one or more of the three clinical scenarios are present, and (3) combined medical and surgical therapy appears to offer the best chance of a cure.

[Tuberculosis in circulation system]

Tuberculous pericarditis develops either via hematogenous or lymphangeal spread, or directly from pulmonary lesions. Tuberculous pericarditis begins with fibrin deposits, granuloma formation, and the presence of live acid-fast bacilli. A pericardial effusion, which is serous but often contains some blood with a high level of protein. Recently, PCR technology has been employed to amplify M. Tuberculosis DNA from pericardial fluid. The elevation of ADA (> 45 U/l) is supportive of the diagnosis. Tuberculous pericarditis is detected clinically either in the effusive stage by nonspecific systemic syndrome or after the development of constrictive pericarditis. The short-course treatment of tuberculous pericarditis should consist of three-drug regimen, such as INH, RFP, PZA, SM, EB. The use of prednisolone is controversial. Tuberculous myocarditis is extremely rare because of low affinity between M. Tuberculosis and myocardium. Most cases of tuberculous pericarditis are clinically silent and diagnosed at autopsy.

Tuberculous pericarditis: long-term outcome in patients who received medical therapy alone

A conservative approach to operative intervention in the treatment of active tuberculous pericarditis was adopted and only 4 of 16 consecutive patients underwent pericardiectomy, all within 2 months of diagnosis. One patient died of constrictive pericarditis despite pericardiectomy, and one died of acute bronchopneumonia after 8 months of otherwise successful medical management. All 14 long-term survivors were reevaluated to exclude chronic constrictive pericarditis and other potential sequelae of tuberculous pericarditis. Reevaluation included physical examination, chest radiograph, electrocardiogram, M-mode and two-dimensional echocardiogram, computed tomography (CT) scan, and in patients less than or equal to 75 years of age, incremental cycle exercise to maximum oxygen consumption. None were found to have chronic constrictive pericarditis or convincing evidence of other recognized complications of tuberculous pericarditis. Our results suggest that when pericardiectomy is not required for the relief of cardiac compression during the acute phase of tuberculous pericarditis and patients are treated with medical therapy alone, an excellent long-term outcome may be anticipated.

Recent experience with tuberculous pericarditis

Twelve patients with tuberculous pericarditis were found among 1,194 patients with tuberculosis treated at the University of Texas Medical Branch over a 10-year period, an incidence of 1%. Surgical treatment was undertaken in 4 patients, and the rest were treated medically. The surgically treated patients had no major complications, and none of them died. In the medically treated group, however, 1 patient died, 1 had an anaerobic empyema, and 1 experienced respiratory arrest. In addition, the average hospital stay was 33 days less in the surgically treated group. Early surgical intervention should be carried out in patients with tuberculous pericarditis who do not respond promptly to adequate antituberculosis chemotherapy.