Development of a Subaortic Aneurysm Secondary to Disseminated Tuberculosis in a Child

Abstract

Subvalvular aneurysms of the left ventricle are very rare and often the cause is uncertain. Very little data in the literature describes subvalvular aneurysms in children and most of the data are derived from case reports. We describe a unique case of a human immunodeficiency virus negative child with a tuberculous subaortic aneurysm observed at different stages of development by serial transthoracic echocardiography. The patient underwent successful cardiac surgery after the initial conservative treatment for tuberculosis (TB).A 3-year-old black boy who was negative for human immunodeficiency virus presented to our institution with a 1-week history of coughing, fever, night sweats, and generalized body swelling. On examination he appeared chronically ill and was underweight for his age. He had generalized lymphadenopathy in the axillary, supraclavicular, cervical, and submandibular regions. He had ascites, hepatomegaly (liver span, 12 cm), and splenomegaly (3 cm below costal margin). The boy was tachypneic with a respiratory rate of 50 breaths/min. He had intercostal and subcostal recession and audible bilateral rhonchi. His heart rate was150 beats/min, with a gallop rhythm present and with muffled heart sounds. There were no murmurs, but he was in congestive cardiac failure. His blood pressure was 80/40 mm Hg.A chest roentgenogram demonstrated cardiomegaly, a widened mediastinum, and paratracheal lymphadenopathy. The C-reactive protein, lactate dehydrogenase levels, and erythrocyte sedimentation rate were elevated. Echocardiography (Fig 1) revealed normal intracardiac anatomy with a large organized and loculated pericardial effusion. A biopsy of a supraclavicular lymph node demonstrated caseating necrosis with sites of granulomatous inflammation. Epitheloid cell granulomas and Langhans giant cells were also seen. The Ziehl Neelsen stain highlighted occasional acid and alcohol fast bacilli, which confirmed the TB. There were no features of lymphoma or malignancy present. Mycobacterium TB was also isolated on cultures of gastric aspirates. A diagnosis of disseminated TB with organized TB pericarditis was made.

Pseudoaneurysm of the mitral–aortic intervalvular fibrosa presenting after chest trauma and diagnosed by cardiac magnetic resonance: a case report

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