J Korean Soc Radiol.  2011 Dec;65(6):563-568. 10.3348/jksr.2011.65.6.563.

Tuberculous Pseudoaneurysm of the Descending Thoracic Aorta from Tuberculous Aortitis: CT Findings and Treatment with an Endovascular Stent Graft

• Yoon JY
• Lee IJ
• Jeon EY
• Kim MJ
• Lee K
• Lee Y

• KMID: 2002922
• DOI: http://doi.org/10.3348/jksr.2011.65.6.563

Abstract

Tuberculous pseudoaneurysms of the aorta are rare entities that have been reported as fatal complications requiring early diagnosis and treatment. Here, we describe a case of a tuberculous pseudoaneurysm of the descending thoracic aorta in a patient with miliary tuberculosis. The computed tomography findings of a tuberculous pseudoaneurysm and outcomes of treatment with endovascular stent graft are described. Tuberculous pseudoaneurysms of the descending thoracic aorta were treated with endovascular stent graft. However, perigraft recurrence of tuberculosis after cessation of antituberculous drugs led to surgical treatment.

MeSH Terms

Aneurysm
Aneurysm, False
Aorta
Aorta, Thoracic
Blood Vessel Prosthesis
Early Diagnosis
Humans
Recurrence
Stents
Transplants
Tuberculosis
Tuberculosis, Miliary

Figure

• 

  Fig. 1 Tuberculous aortitis of the descending thoracic aorta in a 56-year-old man. A. Axial contrast-enhanced CT image at the lung window setting reveals multiple miliary nodules in both lungs. B. The mediastinal window setting shows a crescent shaped periaortic low density lesion (arrow) encasing the aorta in the superior segment of the lower lobe of the left lung. The descending aorta was slightly compressed by the periaortic lesion and the adjacent aortic wall demonstrated a slightly irregular appearance.

• 

  Fig. 2 A tuberculous pseudoaneurysm of the descending thoracic aorta in a 56-year-old man. (A) Axial and (B) reformatted coronal contrast-enhanced CT images at the mediastinal window setting shows a saccular pseudoaneurysm (asterisk) with mural thrombus (T) of the left anterolateral wall of the descending thoracic aorta.

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  Fig. 3 A tuberculous pseudoaneurysm of the descending thoracic aorta in a 56-year-old man. A. Aortography shows the pseudoaneurysm of the descending thoracic aorta without evidence of rupture (arrow). B. Aortography shows successful deployment of the aortic stent and complete exclusion of the pseudoaneurysm without evidence of endoleak after a stent graft insertion.

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  Fig. 4 A tuberculous pseudoaneurysm of the descending thoracic aorta treated with an aortic stent graft in a 56-year-old man. A. Aortography shows focal saccular bulging of the stent graft into the pseudoaneurysm (arrow). B. Aortography shows complete exclusion of the bulged portion of the previous stent graft after an additional stent graft placement. No endovascular leaks were demonstrated.

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  Fig. 5 A tuberculous pseudoaneurysm of the descending thoracic aorta treated with aortic stent graft in a 56-year-old man. A. The follow-up axial contrast-enhanced CT image demonstrates a markedly decreased pseudoaneurysm (arrow) of the descending thoracic aorta. B. Follow-up CT image demonstrates soft tissue density (asterisk) around the endovascular stent graft of the descending thoracic aorta after cessation of antituberculous medication, which is consistent with perigraft infection.

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