RESUMO
A gentleman in his late 30s presented with a history of evening rise of temperature and generalised malaise of 1-week duration. He had associated upper back pain with tingling and numbness of both lower limbs. An unexplained episode of hypotension with hemoptysis propelled a computed tomography (CT) examination of chest which was suggestive of a pseudoaneurysm of the posterior wall of descending thoracic aorta in the vicinity of the Pott's spine with a prevertebral and paravertebral abscess, for which he was referred to vascular surgeons.Tubercular involvement of vasculature is a rare disease, aortic involvement even rarer. Less than 50 cases of vertebral tuberculosis with tubercular thoracic aortic aneurysm have been reported in the medical literature, but the disease carries a colossal mortality and morbidity.After a multidisciplinary teamwork, thoracic endovascular aortic repair was done for exclusion of the aneurysmal segment, with simultaneous antitubercular and broad-spectrum antibiotic chemotherapy. The patient recuperated well.
Assuntos
Falso Aneurisma , Aneurisma da Aorta Torácica , Aortite , Implante de Prótese Vascular , Procedimentos Endovasculares , Tuberculose Cardiovascular , Tuberculose , Masculino , Humanos , Falso Aneurisma/complicações , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/terapia , Aortite/complicações , Aortite/diagnóstico por imagem , Aortite/cirurgia , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Tuberculose Cardiovascular/complicações , Tuberculose Cardiovascular/diagnóstico por imagem , Tuberculose/complicações , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgiaAssuntos
Angina Pectoris/diagnóstico , Insuficiência Cardíaca/diagnóstico , Neoplasias Cardíacas/diagnóstico , Comunicação Interventricular/diagnóstico por imagem , Infarto do Miocárdio/diagnóstico por imagem , Transposição dos Grandes Vasos/diagnóstico por imagem , Tuberculoma/diagnóstico , Tuberculose Cardiovascular/diagnóstico , Adulto , Angina Pectoris/etiologia , Procedimento de Blalock-Taussig , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Diagnóstico Diferencial , Fibroma/complicações , Fibroma/diagnóstico , Insuficiência Cardíaca/etiologia , Neoplasias Cardíacas/complicações , Comunicação Interventricular/cirurgia , Humanos , Imageamento por Ressonância Magnética , Infarto do Miocárdio/etiologia , Miofibroma/complicações , Miofibroma/diagnóstico , Transposição dos Grandes Vasos/cirurgia , Tuberculoma/complicações , Tuberculose Cardiovascular/complicaçõesAssuntos
Falso Aneurisma/microbiologia , Aneurisma Infectado/microbiologia , Aneurisma Ilíaco/microbiologia , Mycobacterium tuberculosis/isolamento & purificação , Artéria Esplênica/microbiologia , Tuberculose Cardiovascular/microbiologia , Adulto , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/terapia , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/terapia , Antituberculosos/uso terapêutico , Embolização Terapêutica , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Aneurisma Ilíaco/terapia , Masculino , Artéria Esplênica/diagnóstico por imagem , Resultado do Tratamento , Tuberculose Cardiovascular/complicações , Tuberculose Cardiovascular/diagnóstico , Tuberculose Cardiovascular/tratamento farmacológicoAssuntos
Falso Aneurisma/diagnóstico , Tuberculose Cardiovascular/diagnóstico , Tuberculose/diagnóstico , Falso Aneurisma/tratamento farmacológico , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Antibióticos Antituberculose/uso terapêutico , Aorta/diagnóstico por imagem , Aorta/patologia , Aorta/cirurgia , Bélgica , Implante de Prótese Vascular , Terapia Combinada , Angiografia por Tomografia Computadorizada , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/tratamento farmacológico , Doença da Artéria Coronariana/etiologia , Doença da Artéria Coronariana/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Tuberculose/complicações , Tuberculose/tratamento farmacológico , Tuberculose/cirurgia , Tuberculose Cardiovascular/complicações , Tuberculose Cardiovascular/tratamento farmacológico , Tuberculose Cardiovascular/cirurgiaRESUMO
A patient with main pulmonary artery mass may have severe symptoms and warrants urgent surgical management, whereas in a stable patient with a diagnosis amenable to medical treatment, medical management should be started while monitoring the size of the lesion. We report a case in which the patient experienced severe right heart dysfunction due to obstruction of the main pulmonary artery, diagnosed as a probable thrombus, and the patient was taken for urgent surgical excision, later diagnosed as tuberculoma on histopathologic examination.
Assuntos
Artéria Pulmonar/diagnóstico por imagem , Estenose de Artéria Pulmonar/etiologia , Tuberculoma/complicações , Tuberculose Cardiovascular/complicações , Procedimentos Cirúrgicos Vasculares/métodos , Adolescente , Diagnóstico Diferencial , Ecocardiografia , Humanos , Masculino , Artéria Pulmonar/cirurgia , Estenose de Artéria Pulmonar/diagnóstico , Estenose de Artéria Pulmonar/cirurgia , Tuberculoma/diagnóstico , Tuberculoma/cirurgia , Tuberculose Cardiovascular/diagnóstico , Tuberculose Cardiovascular/cirurgiaRESUMO
RATIONALE: Tuberculous aortic pseudoaneurysm associated with vertebral tuberculosis is a rare disease but with very high mortality. We review the literature and find 19 reports with 22 patients. Here we report three cases with vertebral tuberculosis, who also have tuberculous pseudoaneurysm of the aorta. These patients were treated by different methods. We try to analyze the epidemiology, pathogenesis, presentation, and management of this disease to find the best treatment. PATIENT CONCERNS: The patients presented with different symptoms such as pain (chest, abdominal or back), fever, blood volume reduction or hemorrhagic shock symptoms. Large mass also could be observed by imaging. In addition to clinical manifestations, enhanced computed tomography or magnetic resonance imaging could also help the diagnosis of this disease. DIAGNOSES: Tuberculous aortic pseudoaneurysm associated with vertebral tuberculosis. INTERVENTIONS: Three patients were treated with anti-tuberculosis(TB) drugs or combined with different sequences surgical treatment: Case 1 refused to receive pseudoaneurysm surgery and only had anti-TB drug treatment; Case 2 received thoracic spinal surgery first; Case 3 received endovascular stent grafting. OUTCOMES: Two patients (case 1 and case 2) who refused to undergo aneurysm surgery died. The last patient (case 3) underwent endovascular repair and antibiotic therapy for tuberculosis, and the postoperative course was uneventful; the patient recovered and survived. LESSONS: Once the diagnosis of tuberculous pseudoaneurysm is confirmed, surgical treatment should be provided immediately combined with anti-tuberculosis drugs. The aim of the treatment is to save lives, prevent relapse, and facilitate the return to normal life, regardless of the size of the pseudoaneurysm. The pseudoaneurysm should be treated first to prevent aneurysm rupture before the vertebral tuberculosis surgery.
Assuntos
Falso Aneurisma , Antituberculosos/uso terapêutico , Aortite , Fusão Vertebral/métodos , Vértebras Torácicas , Tuberculose Cardiovascular , Tuberculose da Coluna Vertebral , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Falso Aneurisma/diagnóstico , Falso Aneurisma/etiologia , Falso Aneurisma/fisiopatologia , Falso Aneurisma/cirurgia , Aortite/diagnóstico , Aortite/etiologia , Aortite/terapia , Terapia Combinada/métodos , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Vértebras Torácicas/microbiologia , Vértebras Torácicas/patologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Tuberculose Cardiovascular/complicações , Tuberculose Cardiovascular/diagnóstico , Tuberculose da Coluna Vertebral/diagnóstico , Tuberculose da Coluna Vertebral/tratamento farmacológico , Tuberculose da Coluna Vertebral/fisiopatologia , Tuberculose da Coluna Vertebral/cirurgiaAssuntos
Calcinose/diagnóstico por imagem , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Angiografia Coronária , Pericardite Constritiva/diagnóstico por imagem , Pericárdio/diagnóstico por imagem , Tuberculose Cardiovascular/diagnóstico por imagem , Calcinose/complicações , Calcinose/cirurgia , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Pericardiectomia , Pericardite Constritiva/complicações , Pericardite Constritiva/cirurgia , Pericárdio/cirurgia , Valor Preditivo dos Testes , Tuberculose Cardiovascular/complicações , Tuberculose Cardiovascular/cirurgiaRESUMO
This report describes the case of a 63-year-old female patient who presented with progressive dyspnea to a specialized internal medicine practice. Prior consultations with her primary care physician and a cardiologist followed by hospitalizations in an acute care hospital and in a specialist clinic for cardiology had not yielded a conclusive diagnosis. During the physical examination, significant bilateral lower extremity edema, as well as pronounced jugular venous distention was noted while in a seated position. This prompted further targeted diagnostic examination and testing and resulted in the final diagnosis of constrictive pericarditis of tuberculous origin.The establishment of the diagnosis is discussed in the context of increasingly technologized medical practice, where clinical skills and the significance of the patient history and physical examination are declining. In addition, we discuss the problem of less common diseases of the myo- and pericardium with primarily diastolic (constrictive or restrictive) dysfunction being overlooked in routine cardiological diagnostic procedures, with a focus on coronary heart disease, valve disorders and the impairment of systolic ventricular function ("ejection fraction").
Assuntos
Dispneia/diagnóstico , Pericardite Constritiva/diagnóstico , Exame Físico/métodos , Exame Físico/tendências , Tuberculose Cardiovascular/diagnóstico , Diagnóstico Diferencial , Dispneia/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Pericardite Constritiva/complicações , Tuberculose Cardiovascular/complicaçõesRESUMO
Aortitis are mainly described in inflammatory disorders such as Takayasu arteritis, giant cell arteritis or Behçet's disease. Aortitis is sometimes qualified as idiopathic. However, differential diagnoses must be searched since they need specific interventions. Infectious aortitis should be ruled out first as its rapid evolution and short-term poor prognosis makes it a therapeutic emergency. Furthermore, rarer differential diagnoses should be known as they require specific care that might sometimes differ from the treatment of inflammatory aortitis, such as retroperitoneal fibrosis mostly idiopathic but also secondary to neoplasia or malignant hemopathies. IgG4 related disease, Erdheim-Chester disease and inflammatory abdominal aortic aneurysm due to atherosclerosis are other differential diagnoses to mention in the presence of aortitis in order to adapt patients' care consequently.
Assuntos
Aortite/diagnóstico , Aortite/etiologia , Síndrome de Behçet/complicações , Síndrome de Behçet/diagnóstico , Diagnóstico Diferencial , Doença de Erdheim-Chester/complicações , Doença de Erdheim-Chester/diagnóstico , Arterite de Células Gigantes/complicações , Arterite de Células Gigantes/diagnóstico , Humanos , Imunoglobulina G/efeitos adversos , Sífilis Cardiovascular/complicações , Sífilis Cardiovascular/diagnóstico , Arterite de Takayasu/complicações , Arterite de Takayasu/diagnóstico , Tuberculose Cardiovascular/complicações , Tuberculose Cardiovascular/diagnósticoAssuntos
Corticosteroides/uso terapêutico , Aorta Torácica/diagnóstico por imagem , Aortite/etiologia , Aortografia , Tuberculose Cardiovascular/complicações , Anti-Hipertensivos/uso terapêutico , Aorta Torácica/patologia , Aortite/diagnóstico por imagem , Aortite/tratamento farmacológico , Constrição Patológica , Quimioterapia Combinada , Feminino , Humanos , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Tuberculose Cardiovascular/diagnósticoRESUMO
In this study, we report the first case of Mycobacterium tuberculosis endocarditis in an immunocompetent child born in the United States. Mass spectrometry of the vegetation identified coagulation, humoral immune proteins, neutrophil granule proteins, and histones. Few neutrophils on histopathology suggest that neutrophil extracellular traps may contribute to tuberculous endocardiac mass formation.
Assuntos
Endocardite Bacteriana/diagnóstico por imagem , Imunocompetência , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Cardiovascular/diagnóstico por imagem , Antituberculosos/uso terapêutico , Medula Óssea/microbiologia , Medula Óssea/patologia , Cromatografia Líquida , Endocardite Bacteriana/complicações , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/imunologia , Endocárdio/química , Feminino , Humanos , Lactente , Linfo-Histiocitose Hemofagocítica/microbiologia , Linfo-Histiocitose Hemofagocítica/patologia , Espectrometria de Massas , Neutrófilos/imunologia , Proteína S/análise , Tuberculose Cardiovascular/complicações , Tuberculose Cardiovascular/tratamento farmacológico , Tuberculose Cardiovascular/imunologia , Estados UnidosRESUMO
Tuberculosis is a public health problem in Morocco, which is difficult to eradicate despite the recognized efficiency of health policies. Aortic aneurysm is rare and lethal complication of spontaneous evolution. Pathophysiological characteristics and the difficulty of early diagnosis worsen the prognosis.
Assuntos
Aorta Abdominal/cirurgia , Aorta Torácica , Aneurisma Aórtico/microbiologia , Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular , Tuberculose Cardiovascular/complicações , Adolescente , Adulto , Antituberculosos/uso terapêutico , Aorta Abdominal/patologia , Aorta Torácica/patologia , Aneurisma Aórtico/diagnóstico , Implante de Prótese Vascular/métodos , Feminino , Humanos , Masculino , Esplenectomia , Resultado do TratamentoRESUMO
Increase in the incidence of drug resistance and association with HIV has led to a resurgence of tuberculosis. However, tubercular arteritis continues to remain a rare entity with a prelidection for the thoracic aorta. We report a tubercular ascending aortic pseudoaneurysm in a patient already on treatment for disseminated tuberculosis who underwent successful surgical repair and also review literature pertaining to this entity.
Assuntos
Falso Aneurisma/etiologia , Aorta/patologia , Tuberculose Cardiovascular/complicações , Adulto , Falso Aneurisma/cirurgia , Antituberculosos/uso terapêutico , Aorta/cirurgia , Arterite/etiologia , Feminino , Humanos , Tuberculose Cardiovascular/tratamento farmacológico , Tuberculose Cardiovascular/patologiaRESUMO
Takayasu's arteritis (TA) is a large vessel vasculitis of unknown aetiology characterised by involvement of the aorta and its major branches. Tuberculous arteritis of the aorta is an uncommon condition usually secondary to the dissemination of Mycobacterium tuberculosis infection from the mediastinum and/or lung to the adjacent aorta; this may mimic TA. We report a case of a 23-year-old woman with cutaneous granulomatous vasculitis and saccular aneurysmal dilation of the aorta and large vessels, and highlight the findings shared by TA and tuberculous arteritis.
Assuntos
Aorta/patologia , Derivação Cardíaca Esquerda , Arterite de Takayasu/diagnóstico , Tuberculose Cardiovascular/diagnóstico , Adulto , Anti-Inflamatórios/administração & dosagem , Antígenos de Bactérias/sangue , Antituberculosos/administração & dosagem , Feminino , Derivação Cardíaca Esquerda/métodos , Humanos , Imunidade Celular , Leucócitos Mononucleares/imunologia , Prednisolona/administração & dosagem , Arterite de Takayasu/complicações , Arterite de Takayasu/microbiologia , Arterite de Takayasu/patologia , Arterite de Takayasu/terapia , Resultado do Tratamento , Tuberculose Cardiovascular/complicações , Tuberculose Cardiovascular/patologia , Tuberculose Cardiovascular/terapiaRESUMO
Tuberculous aortic aneurysm is an extremely rare disease with a high mortality rate. The clinical features of this condition are highly variable, ranging from asymptomatic with or without constitutional symptoms, abdominal pain to frank rupture, bleeding and shock. We herein report the case of a 56-year-old man with a large tuberculous mycotic aneurysm in the abdominal aorta with an initial presentation of repeated attacks of abdominal pain lasting for several months. Due to the vague nature of the initial symptoms, tuberculous aortic aneurysms may take several months to diagnose. This case highlights the importance of having a high index of suspicion and providing timely surgery for this rare but potentially lethal disease.
Assuntos
Dor Abdominal/microbiologia , Aneurisma Infectado/diagnóstico , Antibióticos Antituberculose/administração & dosagem , Aorta Abdominal/microbiologia , Aneurisma da Aorta Abdominal/diagnóstico , Tuberculose Cardiovascular/microbiologia , Dor Abdominal/etiologia , Dor Abdominal/terapia , Aneurisma Infectado/microbiologia , Aneurisma Infectado/terapia , Aorta Abdominal/patologia , Aneurisma da Aorta Abdominal/microbiologia , Aneurisma da Aorta Abdominal/terapia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Tuberculose Cardiovascular/complicações , Tuberculose Cardiovascular/diagnósticoAssuntos
Taquicardia Ventricular/etiologia , Tuberculose Cardiovascular/complicações , Tuberculose dos Linfonodos/complicações , Adulto , Diagnóstico Diferencial , Eletrocardiografia , Cardiopatias/diagnóstico , Cardiopatias/microbiologia , Humanos , Mycobacterium tuberculosis/isolamento & purificação , Miocárdio , Taquicardia Ventricular/diagnóstico , Teste Tuberculínico , Tuberculose Cardiovascular/diagnóstico , Tuberculose dos Linfonodos/diagnósticoRESUMO
Although significant breakthroughs have been achieved in tuberculosis management, we still encounter numerous difficulties in diagnosis and treatment of the disease. Additionally, a new challenge, multidrug-resistant tuberculosis (MDR-TB) with unspecific clinical presentation, often results in delayed diagnosis. In this paper, we reported a case of disseminated tuberculosis with rare presentation of ventricular fibrillation, which proved resistant to both isoniazid and rifampicin. A review of literature showed that ventricular fibrillation or tachycardia in tuberculosis patients with pericarditis or myocarditis has been sporadically reported in the past, but none has been conducted involving patients with MDR-TB infections.
Assuntos
Taquicardia Ventricular/etiologia , Tuberculose Resistente a Múltiplos Medicamentos/complicações , Antituberculosos/uso terapêutico , Ecocardiografia , Feminino , Humanos , Taquicardia Ventricular/diagnóstico , Tuberculose Cardiovascular/complicações , Tuberculose Cardiovascular/diagnóstico , Tuberculose Cardiovascular/tratamento farmacológico , Adulto JovemRESUMO
Extracardiac manifestations of constrictive pericarditis, such as massive ascites and liver cirrhosis, often cover the true situation and lead to a delayed diagnosis. A young female patient was referred to this hospital due to a 4-year history of refractory ascites as the only presenting symptom. A diagnosis of chronic calcified constrictive pericarditis was eventually established based on echocardiography, ultrasonography, and computed tomography. Cardiac catheterization was not performed. Pericardiectomy led to relief of her ascites. Refractory ascites warrants thorough investigation for constrictive pericarditis.
Assuntos
Ascite/etiologia , Calcinose/diagnóstico , Calcinose/cirurgia , Pericardite Constritiva/etiologia , Pericardite Constritiva/cirurgia , Tuberculose Cardiovascular/complicações , Tuberculose Cardiovascular/cirurgia , Ascite/diagnóstico , Ascite/terapia , Calcinose/etiologia , Doença Crônica , Diagnóstico Diferencial , Feminino , Humanos , Pericardiectomia , Falha de Tratamento , Resultado do Tratamento , Tuberculose Cardiovascular/etiologia , Adulto JovemRESUMO
Granulomatous myocarditis is a rare disease of the heart. The present case highlights a potentially life-threatening and rare tubercular involvement of the myocardium in a young woman in the form of granulomas and abscess.