Rare Triple Presentation of Tuberculous Mycotic Aortic Aneurysm

Kiruthika Shanmugam; Shivdasani Ravi; Gopal Murugesan; Vijit Koshy Cherian; Karthik Maruthachalam

doi:doi:10.11648/j.ijcts.20210702.14

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Rare Triple Presentation of Tuberculous Mycotic Aortic Aneurysm

Kiruthika Shanmugam, Shivdasani Ravi, Gopal Murugesan, Vijit Koshy Cherian, Karthik Maruthachalam

Published in International Journal of Cardiovascular and Thoracic Surgery (Volume 7, Issue 2)

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

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[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.
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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
PY  - 2021
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

Kiruthika Shanmugam

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

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

Department of Cardiothoracic and Vascular Surgery, Madras Institute of Orthopaedics and Traumatology International Hospital, Chennai, India
Vijit Koshy Cherian

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

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

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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}
}

Copy | Download

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
PY  - 2021
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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