Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 11-1975

Pulmonary tuberculosis with multiple saccular aneurysms of the aorta--a case report

A forty-eight-year-old man presented with cavitary pulmonary tuberculosis and widening of the mediastinum. Mediastinal widening was due to multiple saccular aneurysms of the ascending aorta and the arch of the aorta. The various presentations of tubercular aortitis and the reasons for considering alternative etiology for the thoracic aneurysms in this case are discussed. The authors report this interesting association of pulmonary tuberculosis with luetic aortic aneurysm.

Surgical treatment of a tuberculous thoracoabdominal aneurysm

We report a case of tuberculous thoracoabdominal aneurysm successfully treated by surgery. Computerized tomography was diagnostic for location and etiology. The therapeutic plan included antituberculosis drug therapy started before surgery, direct PTFE prosthetic replacement and omentoplasty. A survey of other reports dealing with tuberculous abdominal or thoracic aorta involvement shows that their frequency, as that of tuberculosis in general, is diminishing.

Tuberculous aortitis presenting with an aortoduodenal fistula: a case report

An elderly man with tuberculous aortitis presented with massive gastrointestinal bleeding resulting from an aortoduodenal fistula. Aortic resection was successful, and he has done well over a 12 year period. The organism was recovered from the aorta and also seen on section of the neighboring lymph nodes. Although tuberculous aortitis is rare, it should be considered in a patient with prior history of tuberculosis who has developed evidence of aortic disease, aneurysm, or massive gastrointestinal bleeding.

Tuberculous aneurysms of the descending thoracic aorta: report of a case with fatal rupture

Tuberculous aortic aneurysm is a rare disease entity. The majority of affected patients succumb to perforation and exsanguination. The only chance for survival and cure is by resection and prolonged antituberculosis chemotherapy. Our case illustrates the high risk of rupture of tuberculous aortic aneurysms. Post-mortem examination revealed that the mechanism of aneurysm formation was by direct caseous involvement of the descending thoracic aorta from a juxtaposed left upper lobe parenchymal tuberculous process. Our findings also favor the concept that miliary dissemination (in the presence of tuberculous aortic aneurysm) is the result rather than the cause of the tuberculous aortic process.

Early diagnosis of tuberculous thoracic aortic aneurysm by computerized axial tomography

A thoracic aortic aneurysm secondary to miliary tuberculosis was successfully diagnosed early in its course in an asymptomatic patient by computerized axial tomography with contrast enhancement. This non-invasive technique, performed on an outpatient basis, led to the rapid and successful treatment of the patient.

Rupture of a tuberculous pseudoaneurysm of the innominate artery into the trachea and esophagus: report of a case and review of the literature

Spontaneous rupture of a tuberculous pseudoaneurysm of the innominate artery, undiagnosed until necropsy, occurred simultaneously into the trachea and the esophagus in a patient receiving anti-tuberculosis chemotherapy. This is the first reported instance of a tuberculous innominate artery aneurysm, the third tuberculous aneurysm with rupture into the trachea, the sixth into the esophagus, and the first with rupture into both structures. A review of the literature relating to tuberculous aneurysms of the major arteries is provided.