Tuberculosis de aorta ascendente con enfermedad de poncet / Aortic tuberculosis and poncet´disease

La tuberculosis cardiovascular constituye entre 1-3% de los casos de tuberculosis extrapulmonar. En países en vías de desarrollo es causante de 38-83% de los casos de pericarditis constrictiva crónica, mientras que en los países desarrollados, el porcentaje es del 1%. Es más frecuente en hombres entre 30-50 años de edad. Caso: paciente masculino de 36 años de edad quien 2 meses previos a su ingreso, refiere tos con expectoración verdosa y disnea de 15 días de evolución. Se asocia proptosis indolora, limitación para la motilidad ocular, artritis simétrica, aditiva, ascendente desde tobillos hasta rodillas, luego muñecas y codos. Durante hospitalización requiere múltiples pericardiocentesis, por lo cual, se realiza pericardiectomía anterior con hallazgo en biopsia de aorta ascendente: inflamación crónica granulomatosa, BAAR positiva. Se plantea diagnóstico de TBC extrapulmonar: TBC de aorta ascendente complicada con derrame pericárdico, TBC ocular derecha y artritis reactiva por tuberculosis (Enfermedad de Poncet). La tuberculosis cardiovascular constituye una enfermedad poco común, de difícil diagnóstico que conlleva a consecuencias graves si no se trata oportunamente(AU)

Cardiovascular tuberculosis occurs in 1-3% of cases of extrapulmonary tuberculosis. In developing countries causes 38-83% of cases of chronic constrictive pericarditis, while in developed countries it represents 1%. It is more common in men between 30-50 years of age. We present a 36 year old male patient, who two months prior admission, referred productive cough and dyspnea during 15 days. Painless proptosis, limitation of ocular motility, symmetric, additive, ascending arthritis from ankles to knees, wrists and elbows were then associated. During his hospitalization multiple pericardiocentesis were performed, requiring pericardiectomy. The findings in ascending aorta biopsy were: anulomatous chronic inflammation, positive for alcohol resistant bacillus. Final diagnosis: tuberculosis of ascending aorta complicated with pericardial effusion, right eye tuberculosis and ceactive arthritis tuberculosis (Poncet´s disease) .Cardiovascular tuberculosis is a rare disease difficult to diagnose which leads to serious consequences without timely treatment(AU)

Expansile lake of translucency in pericardial effusion. A manifestation of left ventricle to pericardial fistula from rupture of tuberculosis myocardial abscess

A 12 year old boy was admitted to a District hospital with history of abdominal pain, and persistent vomiting of several days duration. Exploratory laparotomy was done and terminal small intestine appearances were suggestive of ileocaecal tuberculosis. During post operative course he was found to have large bilateral pleural effusions on chest x-ray. Subsequently his general condition deteriorated and he was then shifted to tertiary care hospital where chest intubation was done. Echocardiography revealed large pericardial effusion with tamponade which was drained with a pigtail catheter, kept in situ for intermittent drainage. Clinical workup and investigations were consistent with disseminated tuberculosis for which anti-tuberculosis treatment was started. A month later, echocardiography was repeated for removal of pigtail catheter which revealed lake of translucency within the small residual pericardial fluid which was expansile with cardiac cycle. This was further evaluated with colour and colour M-mode. [Panel A,B,C,D]. Findings were suggestive of fistulous communication between left ventricular cavity and pericardial space secondary to tuberculous myocardial abscess rupture confirmed on histopathology post-operatively. What lends novelty to this case is that this serious but apparently innocuous looking finding could easily have been overlooked in a casual examination

Tuberculous aortitis

Tuberculous aortitis [TA] is a rare entity that is invariably indicative of disseminated tuberculosis. TA is associated with aneurysm formation in about half of cases. Another possible complication is perforation of adjacent structures [1-7]. Both abdominal and thoracic aorta are involved with equal frequency.[7-9] Fatal outcomes are frequently reported even after antituberculosis chemotherapy and surgical intervention. We present a case of tuberculous aortic aneurysm [TBAA] that underwent surgical resection and graft replacement in the bed of the infected aorta. Following an apparently successful chemotherapy, the patient died suddenly. We postulate that reactivation of the un-eradicated bacilli precipitated graft failure. Similar cases in the literature are reviewed. We propose lifelong suppressive therapy with antituberculosis agents to prevent such a catastrophic event

Pseudoaneurysm of right ventricle due to localized tuberculosis of myocardium: a case report

A 5-year-old girl was admitted to the hospital with chest pain, fever and dyspnea. Physical examination showed normal heart sounds, diminished pulmonary sounds in the left hemithorax and a normal ECG. On chest X-ray the heart was slightly enlarged with moderate left pleural effusion. CT scan revealed pleural effusion and a hypodense mass at the apex of the heart. A cystic mass was detected by echocardiography as well. The patient was operated as a case of hydatid cyst of the right ventricle. Intraoperatively a pseudoaneurysm of the right ventricle was found. The mass centrally consisted of clots and necrotic tissue and peripherally was composed of fibrosis and calcification. All of these tissues were removed and the communication between the aneurysm and right ventricle was repaired. The diagnosis of tuberculosis was confirmed by culture and microscopic examination. The patient underwent anti- TB treatment for 6 months and remained symptom-free after 4 years. It is believed that local expansion of tuberculous adenitis near the pericardium has caused a TB abscess, which in turn affected the myocardium and destroyed it

Tuberculous Aneurysm of the Abdominal Aorta: Endovascular Repair Using Stent Grafts in Two Cases

Tuberculous aneurysm of the aorta is exceedingly rare. To date, the standard therapy for mycotic aneurysm of the abdominal aorta has been surgery involving in-situ graft placement or extra-anatomic bypass surgery followed by effective anti-tuberculous medication. Only recently has the use of a stent graft in the treat-ment of tuberculous aortic aneurysm been described in the literature. We report two cases in which a tuberculous aneurysm of the abdominal aorta was success-fully repaired using endovascular stent grafts. One case involved is a 42-year-old woman with a large suprarenal abdominal aortic aneurysm and a right psoas abscess, and the other, a 41-year-old man in whom an abdominal aortic aneurysm ruptured during surgical drainage of a psoas abscess.

Tromboflebite tuberculosa: conceito terapêutico / Tuberculosis thrombophlebitis: therapeutic concept

Os autores descrevem cinco casos de tromboflebite desencadeados pelo bacilo de Koch, cujos focos primários näo foram detectados pelos métodos de investigaçöes rotineiramente utilizados para este mister. Trata-se de uma afecçäo vascular periférica de apresentaçäo extremamente rara. As manifestaçöes clínicas que seguem o seu aparecimento têm na dor seu sintoma mais significativo. A ressecçäo cirúrgica dos vasos lesionados foi a conduta mais condizente com a realidade patológica apresentada, já que as medidas clínicas foram incapazes de proporcionar resultados satisfatórios

Tuberculosis of the renal artery.

A young female who underwent nephrectomy for renovascular hypertension was diagnosed on histology to have tuberculosis of the renal artery. This was an isolated finding as there was no tuberculous infection elsewhere including tissues in the vicinity of the vessels. A survey of literature did not yield any reports of tuberculous renal arteritis, making this the first such case.

Thalamic haemorrhage due to tuberculous arteritis.

A young adult presenting as subarachnoid haemorrhage, which was proved to be a thalamic haemorrhage on CT scan, with evidence of tuberculous arteritis, is reported.

Pericarditis tuberculosa en el Hospital Cayetano Heredia: estudio retrospectivo 1969 - 1990 / Tuberculous pericarditis in Hospital Cayetano Heredia: retrospective study 1969 - 1990

Se revisaron las Historias Clínicas de 53 pacientes con pericarditis tuberculosa en el Hospital Cayetano Heredia entre 1969 y 1990. Los criterios de inclusión fueron: BK positivo en Líquido pericárdico (n igual 4), biopsia pericárdica compatible (n igual 3), TBC activa en otro órgano (n igual 27) y PPD mayor de 10mm con exclusión de otras etiologías y buena respuesta al tratamiento antiTBC (n igual 19). El 66 por ciento fueron varones. La población joven se afectó con mayor frecuencia (más del 50 por ciento entre 10 y 39a). La presentación más frecuente fue en las formas agudas y crónica. En la mayoría de casos hubo localización extrapericárdica de la TBC. La pericardiocentesis fue inocua. El líquido pericárdico fue con mayor frecuencia un exudado sanguinolento. El ecocardiograma fue útil en la detección y cuantificación del derrame pericárdico. 20 pacientes recibieron sólo tratamiento antituberculoso, 29 recibieron además esteroides y 4 fueron pericardiectomizados. Sólo 2 pacientes fallecieron (3.7 por ciento). 37 pacientes tuvieron seguimiento con un promedio de 35.2 meses, encontrándose sólo 2 sintomáticos en su último control

Tuberculose miocárdica: relato de um caso e revisäo da literatura / Myocardial tuberculosis: report of a case and review of the literature

O acometimento cardíaco na tuberculose é pouco freqüente devido a uma provável resistência natural do miocárdio a infecçäo pelo Mycobacterium tuberculosis. Säo descritas quatro formas de doença no coraçäo: nodular, difusa infiltrativa e miocardite intesticial inespecífica. As vias de contaminaçäo do miocárdio säo a disseminaçäo hematogênica, a drenagem linfática retrógrada a partir de linfonodos mediastinais contaminados e a infecçäo por contiguidade direta com o pericárdio. A ausência de sintomatologia clínica específica e a dificuldade na identificaçäo de bacilos álcool-resistentes tornam dificil o diagnóstico clínico, contribuindo para a evoluçäo desfavorável na maioria dos casos. Os autores apresentam um caso de tuberculose do miocárdio com acometimento valvar, em doente jovem do sexo feminino tratada cirurgicamente e atualmente no sexto mês de acompanhamento