Rare Triple Presentation of Tuberculous Mycotic Aortic Aneurysm

Abstract

Mycotic Abdominal Aortic Aneurysm (MAAA) is a rare entity that accounts for around 2% of aortic aneurysms. Tuberculous involvement of the aorta is either through hematogenous route or by the way of direct extension of disease from the adjacent structures. It may affect the intima or several layers of the vessel wall resulting in inflammation of the aorta, termed as aortitis, which weakens the aortic wall. The variable immune response to this aortitis can thicken the aorta or can perforate it leading to aneurysm formation. Tuberculosis affects both abdominal and thoracic aorta equally. Neither medical treatment nor surgical repair is curative, when used alone. The various surgical techniques which have been used by the investigators, had refined over period of time and importance of complete clearance of the infective foci is emphasized. Despite advanced imaging techniques, anti-tubercular drugs and adequate surgical options in the present times, the prompt diagnosis and successful repair of tuberculous MAAA are very few in number and there is also possible risk of reactivation of tuberculous process and recurrence. A presentation of a combination of Pott’s spine, psoas abscess and tubercular MAAA is a rare entity with very high mortality. We report the successful surgical and medical treatment of this precarious presentation.