Tuberculous aortitis

Background

• Aortitis caused by Mycobacterium tuberculosis
• Rare, with only 41 cases described from 1945 to 19991
• Pathogenesis may be from either:
  • Contiguous spread from adjacent infection, such as tuberculous adenitis (more common)
  • Hematogenous spread

Clinical Manifestations

• Can be present in either thoracic and abdominal aorta, mostly saccular and false aneurysms
  • Persistent chest, abdominal, or back pain
  • Palpable, pulsatile paraaortic mass
• Often have constitutional symptoms (from active tuberculosis) as well as lymphadenopathy
• Disseminated TB in about half of cases
• Fatal if not diagnosed and treated

Investigations

• Based on a case series of 7 cases in France2:
  • TST should be positive
  • IGRA may be positive or indeterminate
  • CT chest may show lymphadenopathy or pulmonary/pleural tuberculosis, but can be normal
  • CTA shows aortic pseudoaneurysm in aortic or thoracic aorta, or both