Tuberculous aortitis
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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
References
- ^ Richard Long, Randolph Guzman, Howard Greenberg, Janice Safneck, Earl Hershfield. Tuberculous Mycotic Aneurysm of the Aorta. Chest. 1999;115(2):522-531. doi:10.1378/chest.115.2.522.
- ^ Laure Delaval, Tiphaine Goulenok, Paul Achouh, David Saadoun, Julien Gaudric, Quentin Pellenc, Jean-Emmanuel Kahn, Nicoletta Pasi, Damien van Gysel, Patrick Bruneval, Thomas Papo, Karim Sacre. New insights on tuberculous aortitis. Journal of Vascular Surgery. 2017;66(1):209-215. doi:10.1016/j.jvs.2016.11.045.
