Bilateral multiple pulmonary artery aneurysms associated with cavitary pulmonary tuberculosis: a case report.

Autor: Pallangyo P; Department of Cardiovascular Medicine, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania. pedro.pallangyo@gmail.com., Lyimo F; Department of Radiology, Muhimbili National Hospital, P.O Box 65000, Dar es Salaam, Tanzania., Bhalia S; Department of Cardiovascular Medicine, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania., Makungu H; Department of Radiology, Muhimbili National Hospital, P.O Box 65000, Dar es Salaam, Tanzania., Nyangasa B; Department of Cardiovascular Surgery, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania., Lwakatare F; Department of Radiology, Muhimbili National Hospital, P.O Box 65000, Dar es Salaam, Tanzania., Suranyi P; Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courteney Drive, MSC 226, Charleston, SC, 29425, USA., Janabi M; Department of Cardiovascular Medicine, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania.
Jazyk: angličtina
Zdroj: Journal of medical case reports [J Med Case Rep] 2017 Jul 19; Vol. 11 (1), pp. 196. Date of Electronic Publication: 2017 Jul 19.
DOI: 10.1186/s13256-017-1360-x
Abstrakt: Background: Pulmonary artery aneurysms constitute <1% of aneurysms occurring in the thoracic cavity. Congenital cardiac defects are responsible for the majority (>50%) of cases, however, pulmonary artery aneurysm is a rare sequelae of pulmonary tuberculosis reported in about 5% of patients with chronic cavitary tuberculosis on autopsy. The natural history of this potentially fatal condition remains poorly understood and guidelines for optimal management are controversial.
Case Presentation: A 24-year-old man, a nursing student of African descent, was referred to us from an up-country regional hospital with a 4-week history of recurrent episodes of breathlessness, awareness of heartbeats and coughing blood 3 weeks after completing a 6-month course of anti-tuberculosis drugs. A physical examination revealed conjuctival and palmar pallor but there were no stigmata of connective tissue disorders, systemic vasculitides or congenital heart disease. An examination of the cardiovascular system revealed accentuated second heart sound (S 2 ) with early diastolic (grade 1/6) and holosystolic (grade 2/6) murmurs at the pulmonic and tricuspid areas respectively. Blood tests showed iron deficiency anemia, prolonged bleeding time, and mild hyponatremia. A chest radiograph revealed bilateral ovoid-shaped perihilar opacities while a computed tomography scan showed bilateral multiple pulmonary artery pseudoaneurysms with surrounding hematoma together with adjacent cystic changes, consolidations, and tree-in-bud appearance. Our patient refused to undergo surgery and died of aneurismal rupture after 9 days of hospitalization.
Conclusions: The presence of intractable hemoptysis among patients with tuberculosis even after completion of anti-tuberculosis course should raise an index of suspicion for pulmonary artery aneurysm. Furthermore, despite of its rarity, early recognition and timely surgical intervention of pulmonary artery aneurysm is crucial to reducing morbidity and preventing the attributed mortality.
Databáze: MEDLINE
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