Tuberc Respir Dis.  2008 Apr;64(4):298-302. 10.4046/trd.2008.64.4.298.

A Case of Tuberculosis Presented with Pseudoaneurysm of the Aorta and Acute Respiratory Distress Syndrome

• Lee EJ
• Cho HS
• Yoon HS
• Lee JH
• Lee TH
• Yoo KH
• Lee KY
• Kim SJ

• KMID: 1970181
• DOI: http://doi.org/10.4046/trd.2008.64.4.298

Abstract

We experienced a case of tuberculosis presented simultaneously with pseudoaneurysm of the aorta and ARDS. A 63-year-old man was admitted with complaints of fever and right upper quadrant abdominal pain for a week. Chest X-ray on admission showed a normal finding. Sub-diaphragmatic abscess on abdomen CT scan was suspected and serosanguinous fluid was aspirated from the abscess pocket. On day 2, he was getting more dyspneic and chest X-ray revealed extensive bilateral infiltration. Aspirated fluid revealed AFB. Later, follow-up abdomen CT scan revealed a leakage of dye from the aneurysmal sac of the descending aorta which was previously diagnosed as sub-diaphragmatic abscess. An aortic stent was placed, covering the opening into the aneurysm. The sputum also showed positive AFB. The patient was successfully weaned from the ventilator, and discharged with anti-tuberculous medication on day 42. Follow-up abdomen CT scan 6 months later showed that the aneurymal sac was completely disappeared.

Keyword

Tuberculosis; Pseudoaneurysm; ARDS; Stent

MeSH Terms

Abdomen
Abdominal Pain
Abscess
Aneurysm
Aneurysm, False
Aorta
Aorta, Thoracic
Fever
Follow-Up Studies
Humans
Middle Aged
Respiratory Distress Syndrome, Adult
Sputum
Stents
Thorax
Tuberculosis
Ventilators, Mechanical

Figure

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  Figure 1 Initial chest PA shows normal finding on both lung field.

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  Figure 2 Abdominal CT scan image shows a low attenuation lesion (arrow), about 6.2 cm in diameter at the level of diaphragmatic crus.

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  Figure 3 Chest X-ray taken on hospital day 3 reveals bilateral diffuse infiltration.

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  Figure 4 Chest CT image shows diffuse ground glass opacity and consolidation in both lower lobes.

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  Figure 5 Abdominal CT reveals a periaortic fluid collection with leakage of dye from the aorta (arrow), suggesting pseudoaneurysm.

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  Figure 6 On aortogram, Endovascular stent (arrow) covers the opening of pseudoaneurysm in the supraceliac aorta.

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  Figure 7 Follow up abdomen CT scan after 6 months of antituberulosis medication shows the disappearance of the aneurismal sac (arrow).

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