Tubercular pseudoaneurysms of aorta

Background. Tubercular pseudoaneurysm of aorta is a rare but important comp lication of tuberculosis. With worldwide resurgence of tuberculosis due to increasing incidence of drug-resistant tuberculosis and its association wit h acquired immunodeficiency syndrome, the tubercular pseudoaneurysm has bec ome a real clinical entity. Methods. In the past 3 years, 5 young patients (22 to 40 years) presented w ith tubercular pseudoaneurysm. Site of involvement included ascending aorta , distal aortic arch, proximal descending thoracic aorta, distal descending thoracic aorta, and infrarenal abdominal aorta. Two patients had macroscop ic focus of tuberculosis in the nearby vicinity, and all 5 patients had evi dence of active/ treated pulmonary pericardial tuberculosis. All patients e ither had received antitubercular therapy previously or were receiving it a t the time of presentation. Rapid deterioration in the clinical status was the most marked clinical feature. All patients underwent operation. Graft i nterposition was performed in 2, patch repair in 2, and direct closure of t he rent was performed in I patient. All 5 patients received antitubercular therapy in the postoperative period. Results. All patients survived the operation and were discharged from the h ospital. One patient developed recurrence at the original site after 8 mont hs and died at reoperation. The remaining patients are symptom free at 18 t o 36 months postoperatively. Conclusions. A combination of chemotherapy and operation yields gratifying results for the treatment of tubercular pseudoaneurysm. (C) 2001 by The Soc iety of Thoracic Surgeons.