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Communications to the Editor |

Tuberculous Mycotic Aneurysms FREE TO VIEW

Allen Silbergleit, MD, PhD; Agustin Arbulu, MD, FCCP
Author and Funding Information

St. Joseph Mercy-Oakland, Pontiac, MI Harper Hospital, Detroit, Michigan

Correspondence to: Allen Silbergleit, MD, PhD, Director, Department of Surgery, St. Joseph Mercy-Oakland, 900 Woodward Ave, Pontiac, MI 48341-2985



Chest. 1999;116(4):1142. doi:10.1378/chest.116.4.1142
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To the Editor:

We read, with great interest, the fine paper on tuberculous mycotic aneurysms by Long and colleagues (February 1999)1 that recently appeared in CHEST. This topic has been of interest to us for many years, and we appreciate Long et al referring to our 1965 article,2 concerning work that was carried out when we were still surgical residents, several times. A few comments related to our paper may add to the information gleaned by readers of the article by Long et al.1

First, little has changed in reference to this disease in the past 35 years! This is of special interest since the overall progress in medicine has been immense during this period of time, especially so in our field of thoracic and cardiovascular surgery. In 1965, our review of the world medical literature noted a total of 110 patients with tuberculous aortitis. Of these, 59 had no aneurysm formation and 51 had aneurysms (mostly false aneurysms). Currently, only 41 patients with tuberculous aneurysms are noted in the English language medical literature, including the 2 patients cited by Long et al. Successful outcome, then and now, requires combined surgical and medical therapies. The case we added to the literature in 1965 concerned a patient who underwent treatment that was, essentially, identical to that described for the management of current cases. Indeed, all of the following six concepts, which were operative in our 1965 article, were noted in the conclusion of the article by Long et al:

  1. Symptomatic tuberculous aortic aneurysm is very uncommon and requires prompt diagnosis for any chance of successful management.

  2. Clinical presentation may include abdominal pain and a palpable mass.

  3. Medical management alone or surgical management alone is not adequate.

  4. Medical and surgical therapies combined give the best chance for success.

  5. Symptomatic aneurysms must be operated on urgently.

  6. Options for revascularization of the lower body (after resection of the tuberculous aneurysm) include in situ reconstruction with prosthetic graft or extra-anatomic bypass, but anti-tuberculosis (TB) drugs are also required in either instance.

Second, our article described a ruptured tuberculous aneurysm of the abdominal aorta managed successfully with urgent resection, in situ reconstruction with a prosthetic graft, and postoperative anti-TB therapy. Our patient was apparently the first with a ruptured tuberculous aneurysm of the abdominal aorta to survive. At the time that our paper was submitted, the patient was in good condition 17 months after aortic resection.

Finally, we noted that all resected aortic aneurysms should be examined microscopically, since all patients with tuberculous aneurysms do not have a preoperative diagnosis of “tuberculous” and since gross examination of the specimen is not definitive for TB.

References

Long, R, Guzman, R, Greenberg, H, et al (1999) Tuberculous mycotic aneurysm of the aorta.Chest115,522-531. [PubMed] [CrossRef]
 
Silbergleit, A, Arbulu, A, Defever, BA, et al Tuberculous aortitis.JAMA1965;193,83-85
 

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References

Long, R, Guzman, R, Greenberg, H, et al (1999) Tuberculous mycotic aneurysm of the aorta.Chest115,522-531. [PubMed] [CrossRef]
 
Silbergleit, A, Arbulu, A, Defever, BA, et al Tuberculous aortitis.JAMA1965;193,83-85
 
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