Tuberculous aortitis

Case contributed by Dr Daniel J Bell

Presentation

Incidental finding on a CT KUB after presenting with back pain and renal colic. Chronic HIV (viral load <50 and CD4 170).

Patient Data

Age: 40 years
Gender: Male
CT

Normal ascending aorta and aortic arch.

Multiple saccular aneurysms of the descending thoracic aorta, producing a multilobulated appearance of the aorta with variable maximum transverse diameters of 3-4 cm.

Further saccular aneurysms of the suprarenal abdominal aorta.

Aneurysmal dilatation at the level of the renal arteries measuring 4 cm.

Fusiform infrarenal AAA measuring 6.2 cm (~9 cm in length).

No periaortic leak. Periaortic fat stranding is mild.

Satisfactory common and external iliac arteries. Mild aneurysmal dilatation of the proximal right internal iliac measuring 1.3 cm. Mild aneurysmal dilatation of the left CFA.

Unremarkable cardiac appearances (non-cardiac-gated study).
Lungs clear. Calcified subcarinal lymph nodes. No enlarged mediastinal nodes.

Unremarkable liver, spleen, pancreas, kidneys and adrenals.
Small calcified celiac axis nodes. No enlarged abdominopelvic nodes.

No abnormality has been demonstrated in the non-prepared stomach, small or large bowel.

No suspicious bone lesions.

Conclusion
1. Multiple thoracic and abdominal aortic aneurysms are likely mycotic in nature in view of young age, multiplicity, saccular and multilobulated morphology of the aneurysms and lack of imaging/clinical evidence of atheromatous disease.
2. Aneurysms of the proximal right IIA and left CFA.
3. No evidence of other active pathology.

Case Discussion

Lymph node biopsy demonstrated tuberculosis. No other foci of TB nor other infections identified. Patient was started on standard quadruple therapy for TB. He is awaiting vascular surgery for the saccular aneurysms. Aneurysms have mildly increased in size over 10 months.

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Case information

rID: 81854
Published: 4th Sep 2020
Last edited: 13th Sep 2020
System: Vascular
Inclusion in quiz mode: Included
Institution: North Middlesex University Hospital

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