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J Thorac Cardiovasc Surg 2003;125:411-412
© 2003 The American Association for Thoracic Surgery
Brief Communications |
From the Department of Thoracic and Cardiovascular Surgery, Eberhard Karls University, Tübingen, Germany,a and the Department of Thoracic and Cardiovascular Surgery, Regensburg University Hospital, Regensburg, Germany.b
Received for publication June 10, 2002. Accepted for publication June 22, 2002. Address for reprints: Hermann Aebert, MD, Department of Thoracic and Cardiovascular Surgery, Eberhard-Karls-Universität Tübingen, Hoppe-Seyler-Str 3, D-72076 Tübingen, Germany (E-mail: hermann.aebert@med.uni-tuebingen.de.).
| The first 20% of the full text of this article appears below. |
Tuberbculous aneurysms of the aorta are supposed to be exceedingly uncommon. In a recent review of the English literature from 1945 to 1999, 41 cases were counted, with only 2 aneurysms located at the aortic arch.
1 Incidence and presentation of tuberculosis change rapidly because of migration, traveling, and immunosuppression. Multiresistant strains and comorbidity impair the effects of medical therapy and might result in surgical complications. 2 Here we report on 2 patients on whom we have operated for tuberculous pseudoaneurysms of the aortic arch.
Clinical summaries
Patient 1
A 54-year-old man had chronic silicotuberculosis after having worked in a quarry for more than 3 decades. He had a history of heavy smoking and drinking. Five months before the operation, he was admitted to another hospital for fever, weakness, and weight loss of 30 kg within a 2-month period. On the basis of positive sputum cultures and tubercular granulomas in liver and bone marrow biopsy specimens, he was given a diagnosis of reactivated miliary tuberculosis. Although quadruple tuberculostatic therapy somewhat improved his general condition, progressive enlargement of a mediastinal mass was observed during the following months. Computed tomography finally showed a 6-cm saccular aneurysm at the concavity of the aortic arch. The patient was transferred for urgent surgical intervention. On admission to our institution, the patient presented with dyspnea during minimal exertion and a CO diffusion capacity of 35%. Intraoperatively, a false aneurysm with excessive scarring and extremely dense adhesions of all surrounding tissues was encountered. Considering
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