Multiple tuberculous aneurysms of the aorta

Abstract

Tuberculous aneurysms of the aorta are quite rare, but are exceptional when found in multiple locations. We report the case of multiple tuberculous aortic aneurysms of the thoracic and abdominal aorta in a 19-year-old female discovered when she consulted for thrombocytopenic purpura. The treatment for both locations included prolonged antituberculous therapy and surgical resection with cryopreserved aortic allograft patch for the reconstruction.

Endovascular Stent Graft Repair of Multiple Tuberculous Thoracoabdominal Aneurysms

“…About 100 case reports have been published and multiple tuberculous aneurysms of both the thoracic and abdominal aorta are exceptional (1). The natural course of an untreated tuberculous aortic aneurysm is very unfavorable due to aneurysmal rupture and it is not dependent on lesion size.…”

“…Antituberculous drugs after surgery should be continued from 9 to 12 months, furthermore some advocates indefinite use of antituberculous drugs (1). Therefore, antimycobacterial therapy after endovascular treatment should be continued at least 9 months.…”

“…Less than five cases of multiple tuberculous aortic aneurysms have been reported (1)(2)(3)(4). Surgical treatment was performed in three reports and a 16-year-old girl was treated with a multi-layered stent.…”

“…Multiple tuberculous aneurysms of the aorta are extremely rare and fewer than five cases have been reported (1)(2)(3)(4). If patients with a tuberculous aortic aneurysm are not treated properly, they may die due to aneurysm rupture.…”

Cross-sectional imaging of aortic infections

“…It can be caused by direct extension from adjacent tuberculous infected tissue, or by haematogenous seeding from a remote tuberculous focus, the latter suggesting the presence of disseminated tuberculosis [64]. Tuberculous aortitis commonly affects the distal aortic arch and descending thoracic aorta, presenting with a pseudoaneurysm caused by caseous necrosis of the aortic wall [65]. On cross-sectional imaging, tubercular aortitis often appears as a focal, saccular pseudoaneurysm with multiple lobular outpouchings and an irregular, thickened aortic wall [66].…”