A Rare and Fatal Case of Aortobronchial Fistula Secondary to Disseminated Tuberculous Aortitis and Takayasu Arteritis

Abstract

BACKGROUND Aortobronchial fistula (ABF) is a rare complication of a chronic thoracic aneurysm. An ABF secondary to Disseminated Tuberculous (TB) Aortitis and Takayasu Arteritis (TA) may present with extensive combinations of aneurysms and stenoses in different parts of the arterial system with involvement of other organs. CASE PRESENTATION A 29-year-old Filipino female, married, who was admitted to our institution due to sudden massive hemoptysis. A Computed Tomography of the chest showed pulmonary tuberculosis with lymph node involvement and pseudoaneurysm of the descending aorta. The pertinent physical examinations are blood pressure (BP) differential of 20mmhg of upper extremities, painless multiple nodular tongue, multiple cervical, and supraclavicular lymphadenopathies, grade 3/6 holosystolic murmur. On Computed Tomography of the aorta, there are combinations of aneurysms of the mid to distal descending thoracic aorta, distal abdominal aorta, superior mesenteric artery with stenoses of the subclavian and left renal arteries. She was immediately started on anti-TB medications, corticosteroids and was scheduled for aortic aneurysmal repair. However, there was a recurrence of massive hemoptysis leading to her demise. An autopsy of the thorax and abdomen revealed an acute pulmonary hemorrhage, aortobronchial fistula secondary to Disseminated Tuberculous Aortitis and Takayasu Arteritis. CONCLUSION A masked ABF should be suspected in a patient with massive hemoptysis and a pseudoaneurysm of the descending aorta. In a young female with disseminated TB aortitis, a concomitant TA should be investigated. Both can share the same clinical, radiological and pathologic features. It is fatal and needs prompt surgical or endovascular intervention.

Complicated Mycotic Thoracic Aortic Aneurysm Secondary to Staphylococcus aureus Endocarditis

“…1 Among the other causative organisms of mycotic aortic aneurysm (MAA) reported from the Philippines are Salmonella, Mycobacterium tuberculosis, Burkholderia pseudomallei and Neisseria gonorrhoeae. [2][3][4][5][6] The difficulty in diagnosis and management is due to the rarity of the condition, the insidiousness of the presentation and the high-risk condition of the affected patients, all of which complicate medical and surgical treatment. This case study describes a virulent methicillin-resistant S aureus (MRSA) IE complicated by contained rupture of MAA and post-procedural endoleak type IIIa, treated with culture-guided antibiotics and a timely hybrid, two-staged procedure combined with the deployment of two overlapped thoracic endografts.…”