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Rare Triple Presentation of Tuberculous Mycotic Aortic Aneurysm

Received: 22 January 2021     Accepted: 28 June 2021     Published: 8 July 2021
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Abstract

Mycotic Abdominal Aortic Aneurysm (MAAA) is a rare entity that accounts for around 2% of aortic aneurysms. Tuberculous involvement of the aorta is either through hematogenous route or by the way of direct extension of disease from the adjacent structures. It may affect the intima or several layers of the vessel wall resulting in inflammation of the aorta, termed as aortitis, which weakens the aortic wall. The variable immune response to this aortitis can thicken the aorta or can perforate it leading to aneurysm formation. Tuberculosis affects both abdominal and thoracic aorta equally. Neither medical treatment nor surgical repair is curative, when used alone. The various surgical techniques which have been used by the investigators, had refined over period of time and importance of complete clearance of the infective foci is emphasized. Despite advanced imaging techniques, anti-tubercular drugs and adequate surgical options in the present times, the prompt diagnosis and successful repair of tuberculous MAAA are very few in number and there is also possible risk of reactivation of tuberculous process and recurrence. A presentation of a combination of Pott’s spine, psoas abscess and tubercular MAAA is a rare entity with very high mortality. We report the successful surgical and medical treatment of this precarious presentation.

Published in International Journal of Cardiovascular and Thoracic Surgery (Volume 7, Issue 2)
DOI 10.11648/j.ijcts.20210702.14
Page(s) 30-33
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Tuberculosis, Mycotic Aortic Aneurysm, Pott’s Spine, Psoas Abscess

References
[1] Leo PJ, Pearl J, Tsang W. Mycotic aneurysm: a diagnostic challenge. Am J Emerg Med. 1996; 14 (1): 70-73. doi: 10.1016/S0735-6757(96)90019-4.
[2] Long R, Guzman R, Greenberg H, Safneck J, Hershfield E. Tuberculous mycotic aneurysm of the aorta: review of published medical and surgical experience. Chest. 1999; 115 (2): 522-531. doi: 10.1378/chest.115.2.522.
[3] Rob cg, eastcotthh. Aortic aneurysm due to tuberculous lymphadenitis. Br Med J. 1955; 1 (4910): 378-379. doi: 10.1136/bmj.1.4910.378.
[4] Xue J, Yao Y, Liu L. Treatment of tuberculous aortic pseudoaneurysm associated with vertebral tuberculosis: A case series and a literature review. Medicine (Baltimore). 2018; 97 (15): e0382. doi: 10.1097/MD.0000000000010382.
[5] Choudhary SK, Bhan A, Talwar S, Goyal M, Sharma S, Venugopal P. Tubercular pseudoaneurysms of aorta. Ann Thorac Surg. 2001; 72 (4): 1239-1244. doi: 10.1016/s0003-4975(01)03002-8.
[6] Canaud L, Marzelle J, Bassinet L, Carrié AS, Desgranges P, Becquemin JP. Tuberculous aneurysms of the abdominal aorta. J Vasc Surg. 2008 Oct; 48 (4): 1012-6. doi: 10.1016/j.jvs.2008.05.012. PMID: 18992419.
[7] Hatem CM, Kantis GA, Christoforou D, Gold JP, Plestis KA. Tuberculous aneurysm of the descending thoracic aorta. J ThoracCardiovasc Surg. 2002 Feb; 123 (2): 373-4. doi: 10.1067/mtc.2002.120721. PMID: 11828309.
[8] Labrousse L, Montaudon M, Le Guyader A, Choukroun E, Laurent F, Deville C. Endovascular treatment of a tuberculous infected aneurysm of the descending thoracic aorta: a word of caution. J Vasc Surg. 2007 Oct; 46 (4): 786-8. doi: 10.1016/j.jvs.2007.05.038. PMID: 17903655.
[9] Falkensammer J, Behensky H, Gruber H, Prodinger WM, Fraedrich G. Successful treatment of a tuberculous vertebral osteomyelitis eroding the thoracoabdominal aorta: a case report. J Vasc Surg. 2005 Nov; 42 (5): 1010-3. doi: 10.1016/j.jvs.2005.07.011. PMID: 16275463.
[10] Jain AK, Chauhan RS, Dhammi IK, Maheshwari AV, Ray R. Tubercular pseudoaneurysm of aorta: a rare association with vertebral tuberculosis. Spine J. 2007 Mar-Apr; 7 (2): 249-53. doi: 10.1016/j.spinee.2006.04.021. PMID: 17321978.
[11] Sicard GA, Reilly JM, Doblas M, Orgaz A, Rubin BG, Flye MW, Thompson RW, Allen BT. Autologous vein reconstruction in prosthetic graft infections. Eur J VascEndovasc Surg. 1997 Dec; 14 Suppl A: 93-8. doi: 10.1016/s1078-5884(97)80163-3. PMID: 9467624.
[12] Silbergleit A, Arbulu A. Tuberculous mycotic aneurysms. Chest. 1999 Oct; 116 (4): 1142. doi: 10.1378/chest.116.4.1142. PMID: 10531195.
[13] Blumberg HM, Burman WJ, Chaisson RE, Daley CL, Etkind SC, Friedman LN, Fujiwara P, Grzemska M, Hopewell PC, Iseman MD, Jasmer RM, Koppaka V, Menzies RI, O'Brien RJ, Reves RR, Reichman LB, Simone PM, Starke JR, Vernon AA; American Thoracic Society, Centers for Disease Control and Prevention and the Infectious Diseases Society. American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis. Am J RespirCrit Care Med. 2003 Feb 15; 167 (4): 603-62. doi: 10.1164/rccm.167.4.603. PMID: 12588714.
[14] Vogt PR, von Segesser LK, Goffin Y, Pasic M, Turina MI. Cryopreserved arterial homografts for in situ reconstruction of mycotic aneurysms and prosthetic graft infection. Eur J Cardiothorac Surg. 1995; 9 (9): 502-6. doi: 10.1016/s1010-7940(95)80050-6. PMID: 8800699.
[15] 1Razavi MK, Razavi MD. Stent-graft treatment of mycotic aneurysms: a review of the current literature. J VascIntervRadiol. 2008 Jun; 19 (6 Suppl): S51-6. doi: 10.1016/j.jvir.2008.02.012. PMID: 18502387.
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  • APA Style

    Kiruthika Shanmugam, Shivdasani Ravi, Gopal Murugesan, Vijit Koshy Cherian, Karthik Maruthachalam. (2021). Rare Triple Presentation of Tuberculous Mycotic Aortic Aneurysm. International Journal of Cardiovascular and Thoracic Surgery, 7(2), 30-33. https://doi.org/10.11648/j.ijcts.20210702.14

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    ACS Style

    Kiruthika Shanmugam; Shivdasani Ravi; Gopal Murugesan; Vijit Koshy Cherian; Karthik Maruthachalam. Rare Triple Presentation of Tuberculous Mycotic Aortic Aneurysm. Int. J. Cardiovasc. Thorac. Surg. 2021, 7(2), 30-33. doi: 10.11648/j.ijcts.20210702.14

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    AMA Style

    Kiruthika Shanmugam, Shivdasani Ravi, Gopal Murugesan, Vijit Koshy Cherian, Karthik Maruthachalam. Rare Triple Presentation of Tuberculous Mycotic Aortic Aneurysm. Int J Cardiovasc Thorac Surg. 2021;7(2):30-33. doi: 10.11648/j.ijcts.20210702.14

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  • @article{10.11648/j.ijcts.20210702.14,
      author = {Kiruthika Shanmugam and Shivdasani Ravi and Gopal Murugesan and Vijit Koshy Cherian and Karthik Maruthachalam},
      title = {Rare Triple Presentation of Tuberculous Mycotic Aortic Aneurysm},
      journal = {International Journal of Cardiovascular and Thoracic Surgery},
      volume = {7},
      number = {2},
      pages = {30-33},
      doi = {10.11648/j.ijcts.20210702.14},
      url = {https://doi.org/10.11648/j.ijcts.20210702.14},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcts.20210702.14},
      abstract = {Mycotic Abdominal Aortic Aneurysm (MAAA) is a rare entity that accounts for around 2% of aortic aneurysms. Tuberculous involvement of the aorta is either through hematogenous route or by the way of direct extension of disease from the adjacent structures. It may affect the intima or several layers of the vessel wall resulting in inflammation of the aorta, termed as aortitis, which weakens the aortic wall. The variable immune response to this aortitis can thicken the aorta or can perforate it leading to aneurysm formation. Tuberculosis affects both abdominal and thoracic aorta equally. Neither medical treatment nor surgical repair is curative, when used alone. The various surgical techniques which have been used by the investigators, had refined over period of time and importance of complete clearance of the infective foci is emphasized. Despite advanced imaging techniques, anti-tubercular drugs and adequate surgical options in the present times, the prompt diagnosis and successful repair of tuberculous MAAA are very few in number and there is also possible risk of reactivation of tuberculous process and recurrence. A presentation of a combination of Pott’s spine, psoas abscess and tubercular MAAA is a rare entity with very high mortality. We report the successful surgical and medical treatment of this precarious presentation.},
     year = {2021}
    }
    

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  • TY  - JOUR
    T1  - Rare Triple Presentation of Tuberculous Mycotic Aortic Aneurysm
    AU  - Kiruthika Shanmugam
    AU  - Shivdasani Ravi
    AU  - Gopal Murugesan
    AU  - Vijit Koshy Cherian
    AU  - Karthik Maruthachalam
    Y1  - 2021/07/08
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    N1  - https://doi.org/10.11648/j.ijcts.20210702.14
    DO  - 10.11648/j.ijcts.20210702.14
    T2  - International Journal of Cardiovascular and Thoracic Surgery
    JF  - International Journal of Cardiovascular and Thoracic Surgery
    JO  - International Journal of Cardiovascular and Thoracic Surgery
    SP  - 30
    EP  - 33
    PB  - Science Publishing Group
    SN  - 2575-4882
    UR  - https://doi.org/10.11648/j.ijcts.20210702.14
    AB  - Mycotic Abdominal Aortic Aneurysm (MAAA) is a rare entity that accounts for around 2% of aortic aneurysms. Tuberculous involvement of the aorta is either through hematogenous route or by the way of direct extension of disease from the adjacent structures. It may affect the intima or several layers of the vessel wall resulting in inflammation of the aorta, termed as aortitis, which weakens the aortic wall. The variable immune response to this aortitis can thicken the aorta or can perforate it leading to aneurysm formation. Tuberculosis affects both abdominal and thoracic aorta equally. Neither medical treatment nor surgical repair is curative, when used alone. The various surgical techniques which have been used by the investigators, had refined over period of time and importance of complete clearance of the infective foci is emphasized. Despite advanced imaging techniques, anti-tubercular drugs and adequate surgical options in the present times, the prompt diagnosis and successful repair of tuberculous MAAA are very few in number and there is also possible risk of reactivation of tuberculous process and recurrence. A presentation of a combination of Pott’s spine, psoas abscess and tubercular MAAA is a rare entity with very high mortality. We report the successful surgical and medical treatment of this precarious presentation.
    VL  - 7
    IS  - 2
    ER  - 

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Author Information
  • Department of Cardiothoracic and Vascular Surgery, Madras Institute of Orthopaedics and Traumatology International Hospital, Chennai, India

  • Department of Cardiothoracic and Vascular Surgery, Madras Institute of Orthopaedics and Traumatology International Hospital, Chennai, India

  • Department of Cardiothoracic and Vascular Surgery, Madras Institute of Orthopaedics and Traumatology International Hospital, Chennai, India

  • Department of Cardiothoracic and Vascular Surgery, Madras Institute of Orthopaedics and Traumatology International Hospital, Chennai, India

  • Department of Surgical Gastroenterology, Madras Institute of Orthopaedics and Traumatology International Hospital, Chennai, India

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