Hepatic Artery Pseudoaneurysms in a Patient Treated for Miliary Tuberculosis.

Abstract

A 70-year-old womanwith fever was admitted to our hospital. She was diagnosed as miliary tuberculosis and treated with antituberculous drugs. After seven weeks of therapy, she developed a sudden sharp upper abdominal pain and shock. Angiography of the celiac artery showed two hepatic artery pseudoaneurysms with extravasation. The hemorrhage was successfully stopped by microcoil embolization. The clinical course suggested that miliary tuberculosis had caused the pseudoaneurysms. Although aneurysms rarely occur as a complication of miliary tuberculosis, they should be diagnosed as early as possible because of the high rate of rupture and associated high mortality rate. (Internal Medicine 39: 994-998, 2000)

Ruptured tuberculous aneurysms of the abdominal aorta: Two case series

“…The pathogenesis of the aortic tuberculous aneurysm includes several mechanisms: the most common mode of transmission is a direct extension from the contiguous focus of tuberculous lymph nodes, the hematogeneous spread to the arterial intima, and the septic embolization of the arterial wall via the vasa vasorum or the lymphatics [13] , [14] . Direct spread of infection to the abdominal aorta may occur from nearby retroperitoneal lymphadenitis, intestinal tuberculosis, spondylitis, psoas abscess, or the prostate [15] , [16] .…”

“…Endovascular repair should be restricted to the patient with rupture or at high surgical risk. The treatment of arterial rupture with coil combined with medical therapy has been proposed in cases where restoration of arterial patency is not required such as branches of the aorta [30] . Some authors propose lifelong antibiotic treatment after prosthetic graft implantation [21] .…”

Sudden death caused by pulmonary fat embolism in a patient with miliary tuberculosis

“…Tuberculous aneurysms of splanchnic and peripheral arteries are also predisposed to massive exsanguination. Tuberculous aneurysms of renal, brachiocephalic, femoral, common iliac, and hepatic arteries have been reported 51. Beeresha et al52 described a 13-year-old boy presenting with SD due to massive intraperitoneal bleeding, in whom the cause of death was an aneurysm rupture of the hepatic artery of tuberculous etiology.…”

Selective jejunal artery pseudoaneurysm embolization in a patient with massive gastrointestinal bleeding due to intestinal tuberculosis

“…Pseudoaneurysms due to intestinal tuberculosis have been described previously in the aorta, the femoral artery and the visceral arteries, such as celiac, hepatic, gastroduodenal and superior mesenteric artery (3)(4)(5)(6)(7)(8).…”