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Tuberculous Aortic Pseudoaneurysm: An Unexpected Encounter with an Old Acquaintance

INTRODUCTION: Mycobacterium tuberculosis (MT) is a rare cause of mycotic aneurysms. Diagnosis and management of tuberculous arterial infection is challenging. A case of a patient diagnosed and successfully treated for an aortic pseudoaneurysm caused by MT infection is reported. REPORT: An 83 year ol...

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Detalles Bibliográficos
Autores principales: Coelho, Nuno Henriques, Martins, Victor, Canedo, Alexandra
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9257338/
https://www.ncbi.nlm.nih.gov/pubmed/35812071
http://dx.doi.org/10.1016/j.ejvsvf.2022.01.009
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author Coelho, Nuno Henriques
Martins, Victor
Canedo, Alexandra
author_facet Coelho, Nuno Henriques
Martins, Victor
Canedo, Alexandra
author_sort Coelho, Nuno Henriques
collection PubMed
description INTRODUCTION: Mycobacterium tuberculosis (MT) is a rare cause of mycotic aneurysms. Diagnosis and management of tuberculous arterial infection is challenging. A case of a patient diagnosed and successfully treated for an aortic pseudoaneurysm caused by MT infection is reported. REPORT: An 83 year old man was admitted with recurrent back pain over five months associated with constitutional symptoms. Computed tomography angiography (CTA) revealed a psoas collection associated with terminal aorta and proximal left common iliac artery posterolateral wall ulceration. Percutaneous drainage was performed and both the acid fast bacillus test and the molecular test for MT DNA were positive. The patient started on anti-tuberculous treatment, showing an excellent response. Three month CTA revealed arterial ulceration stability. However, the six month CTA revealed evolution to an asymptomatic 40 mm pseudoaneurysm. He was submitted to open repair with an aorto-bi-iliac interposition silver acetate/triclosan collagen coated polyester graft. The post-operative course was uneventful. DISCUSSION: Increased awareness and pursuit of an histological and microbiological diagnosis along with close surveillance allow anticipation of complications that can develop without any warning symptoms, as reported in this case. Agent identification and a combination of prolonged anti-tuberculous drug therapy with extensive excision of the infected field along with aortic reconstruction contributed to a good outcome.
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spelling pubmed-92573382022-07-07 Tuberculous Aortic Pseudoaneurysm: An Unexpected Encounter with an Old Acquaintance Coelho, Nuno Henriques Martins, Victor Canedo, Alexandra EJVES Vasc Forum Case Report INTRODUCTION: Mycobacterium tuberculosis (MT) is a rare cause of mycotic aneurysms. Diagnosis and management of tuberculous arterial infection is challenging. A case of a patient diagnosed and successfully treated for an aortic pseudoaneurysm caused by MT infection is reported. REPORT: An 83 year old man was admitted with recurrent back pain over five months associated with constitutional symptoms. Computed tomography angiography (CTA) revealed a psoas collection associated with terminal aorta and proximal left common iliac artery posterolateral wall ulceration. Percutaneous drainage was performed and both the acid fast bacillus test and the molecular test for MT DNA were positive. The patient started on anti-tuberculous treatment, showing an excellent response. Three month CTA revealed arterial ulceration stability. However, the six month CTA revealed evolution to an asymptomatic 40 mm pseudoaneurysm. He was submitted to open repair with an aorto-bi-iliac interposition silver acetate/triclosan collagen coated polyester graft. The post-operative course was uneventful. DISCUSSION: Increased awareness and pursuit of an histological and microbiological diagnosis along with close surveillance allow anticipation of complications that can develop without any warning symptoms, as reported in this case. Agent identification and a combination of prolonged anti-tuberculous drug therapy with extensive excision of the infected field along with aortic reconstruction contributed to a good outcome. Elsevier 2022-01-23 /pmc/articles/PMC9257338/ /pubmed/35812071 http://dx.doi.org/10.1016/j.ejvsvf.2022.01.009 Text en © 2022 Published by Elsevier Ltd on behalf of European Society for Vascular Surgery. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Case Report
Coelho, Nuno Henriques
Martins, Victor
Canedo, Alexandra
Tuberculous Aortic Pseudoaneurysm: An Unexpected Encounter with an Old Acquaintance
title Tuberculous Aortic Pseudoaneurysm: An Unexpected Encounter with an Old Acquaintance
title_full Tuberculous Aortic Pseudoaneurysm: An Unexpected Encounter with an Old Acquaintance
title_fullStr Tuberculous Aortic Pseudoaneurysm: An Unexpected Encounter with an Old Acquaintance
title_full_unstemmed Tuberculous Aortic Pseudoaneurysm: An Unexpected Encounter with an Old Acquaintance
title_short Tuberculous Aortic Pseudoaneurysm: An Unexpected Encounter with an Old Acquaintance
title_sort tuberculous aortic pseudoaneurysm: an unexpected encounter with an old acquaintance
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9257338/
https://www.ncbi.nlm.nih.gov/pubmed/35812071
http://dx.doi.org/10.1016/j.ejvsvf.2022.01.009
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