Extracranial carotid artery pseudoaneurysm due to Mycobacterium tuberculosis

Abstract

Mycobacterium tuberculosis is a very rare cause of extracranial carotid artery pseudoaneurysm. A 39-year-old man presented with a rapidly increasing neck mass and hoarseness of voice for 15 days. He was on antitubercular treatment for pulmonary tuberculosis. Computed tomography angiography showed a large pseudoaneurysm of the right common carotid artery. Emergency surgery was performed to excise the pseudoaneurysm sac and repair the artery with a Dacron graft. Postoperative angiography showed normal flow in the carotids and cerebral circulation. Histology of the excised tissue was consistent with a tubercular etiology of the pseudoaneurysm.

Acute periapical dental abscesses and increased risk for extracranial carotid artery aneurysms

“…Although not common, infection triggering an inflammatory process can be associated with ECAA [19,20]. Primary mycotic or infected aneurysms of the aorta represent 0.65% to 1.3% of all aortic aneurysms [21].…”

Mycotic internal carotid artery pseudoaneurysm secondary to Mycobacterium tuberculosis

“… 1 , 2 , 3 , 14 , 15 , 16 Although historically more prevalent, M tuberculosis has been a rare causative pathogen in the formation of mycotic carotid aneurysms for the last century, with only four previous cases reported in literature. 2 , 3 , 17 Mycobacterial mycotic aneurysms in the carotid artery have also been described after bacillus Calmette-Guerin therapy for bladder cancer. 18 , 19 …”

“…[1][2][3][14][15][16] Although historically more prevalent, mycobacterium tuberculosis has been a rare causative pathogen in the formation of mycotic carotid aneurysms for the last century, with only four previous cases reported in literature. 2,3,17 Mycobacterial mycotic aneurysms in the carotid artery have also been described after bacillus Calmette-Guerin (BCG) therapy for bladder cancer. 18,19 The pathogenesis of mycotic aneurysms involving m tuberculosis begins with either (1) external invasion of the bacilli through tunica adventitia and media via seeding from vasa vasorum, adjacent lymph nodes, or adjacent abscess, or rarely (2) direct hematogenous seeding of tuberculous bacilli to the tunica intima (especially around atherosclerotic plaques).…”