CT Imaging Manifestations of Tubercular Aortic Aneurysm

Abstract

Tubercular aortic aneurysm is a rare complication of tuberculosis but associated with very high mortality. Early diagnosis is critical, however, it is challenging due to nonspecific symptoms. This study summarized the CT features of tubercular aortic aneurysm in order to assist timely clinical diagnosis. Seventeen patients with confirmed tubercular aortic aneurysm between 2016 and 2020 were included in this study. The clinical manifestations, past medical history, laboratory and imaging examinations, treatments and other data were collected. CT angiography was routinely performed in all patients. Clinical and CT imaging data was collected and analyzed. All tuberculous aneurysms were pseudoaneurysms, which were located in the thoracic aorta, abdominal aorta, junction of thoracic and abdominal aorta or iliac aorta. The shapes of aneurysms were saccular or lobular. The diameter of aneurysm ranged from 30 to 120 mm. Thirteen patients had atherosclerosis. Mural thrombus was shown in 14 patients. Twelve patients showed enlarged lymph nodes which were found closely related to the aneurysm. Nine patients had tuberculous spondylitis including tuberculosis of thoracic lumbar and lumbosacral spine. Psoas abscess was showed in four patients and iliopsoas abscess was in one patient. Compared with other infectious aneurysms, tuberculous aneurysms typically show more cystic and lobulated shapes on CT scan, which are imaged as poured and unstressed. Another point of differential diagnosis is that the surrounding tissues and adjacent organs of tubercular aneurysms are usually infected with tuberculosis and most of them are accompanied by other sites of tuberculosis.