Type A Aortic Dissection during the Treatment of Tuberculous Pericarditis
10.4326/jjcvs.41.16
- VernacularTitle:結核性心膜炎の治療中に発症した急性 A 型大動脈解離の1例
- Author:
Tomoyuki Matsuba
;
Goichi Yotsumoto
;
Kousuke Mukaihara
;
Takayuki Ueno
;
Kazuhisa Matsumoto
;
Yoshihiro Fukumoto
;
Hitoshi Toyohira
;
Masafumi Yamashita
- Publication Type:Journal Article
- Keywords:
tuberculous pericarditis;
tuberculous aortitis;
acute aortic dissection;
in situ reconstruction
- From:Japanese Journal of Cardiovascular Surgery
2012;41(1):16-20
- CountryJapan
- Language:Japanese
-
Abstract:
A 69-year-old woman, who had undergone a right nephrectomy for renal tuberculosis in her teens, was admitted with a low grade fever, anorexia and progressive dyspnea. Transthoracic echocardiography showed cardiac tamponade and chest CT revealed an enlarged ascending aorta. She was treated with pericardiocentesis. Specimens of pericardial effusion failed to demonstrate any acid-fast bacilli, but they did reveal a high level of adnosine deaminase (72 IU/l). A diagnosis of tuberculous pericarditis was considered, and antituberculous chemotherapy was started. However, he presented with severe back pain 32 days later and CT revealed type A acute aortic dissection. We therefore replaced the ascending aorta and aortic root. A histopathological examination of the ascending aorta revealed evidence of a granulomatous inflammatory reaction with Langhans giant cells. She thereafter received antituberculous chemotherapy with 4 drugs for 2 months, with continued rifampicin and isoniazid treatment. There was no evidence of any graft infection after 70 days.
