Posterior mediastinal nodule diagnosed as a tuberculous granuloma infiltrating into the aorta
- PDF / 1,054,897 Bytes
- 5 Pages / 595.276 x 790.866 pts Page_size
- 83 Downloads / 197 Views
CASE REPORT
Posterior mediastinal nodule diagnosed as a tuberculous granuloma infiltrating into the aorta Kazuto Sugai1 · Hideo Ichimura1,2,3 · Yasuharu Sekine1 · Keisuke Kobayashi1 · Kanji Matsuzaki3,4 · Kei Shimizu5 · Akiko Sakata6 · Yukio Sato2 Received: 11 July 2020 / Accepted: 21 September 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Although tuberculous infection rarely results in aortic aneurysm formation or rupture, its precursor lesion has never been identified in cases with tuberculosis. We incidentally encountered a case of a posterior mediastinal nodule with concomitant chest computed tomography (CT) findings of multiple pulmonary micronodular shadows. Since an enlargement of the mediastinal nodule was retrospectively apparent, we considered the lesion as malignant. Enhanced CT showed luminal irregularity in the descending aorta, located adjacent to the nodule, in addition to the disappearance of the fat plane between the lesion and the aorta. We successfully resected the nodule with the aorta under partial cardiopulmonary bypass. Based on the pathological and postoperative bacterial findings, the nodule was diagnosed as a tuberculous granuloma infiltrating into the medial layer of the aorta. Keywords Aorta · Posterior mediastinal nodule · Pulmonary lesion · Tuberculosis · Tuberculous granuloma
Introduction Tuberculous infections rarely involve the aorta and result in aneurysm formation, rupture, or stenosis [1, 2]. While most previously reported cases were severe at the time of diagnosis, a conspicuous precursor lesion in a latent state, which is indicative of aortic involvement, has not been previously pathologically confirmed. We herein describe a patient with a posterior mediastinal nodule that was diagnosed as a * Hideo Ichimura [email protected] 1
Department of Thoracic Surgery, Hitachi General Hospital, 2‑1‑1 Jyounan, Hitachi, Ibaraki 317‑0077, Japan
2
Department of Thoracic Surgery, University of Tsukuba, 1‑1‑1 Tennodai, Tsukuba, Ibaraki 305‑8575, Japan
3
Hitachi Medical Education and Research Center, Faculty of Medicine, University of Tsukuba, 2‑1‑1 Jyounan, Hitachi, Ibaraki 317‑0077, Japan
4
Department of Cardiovascular Surgery, Hitachi General Hospital, Hitachi, Japan
5
Department of Respiratory Medicine, Hitachi General Hospital, Hitachi, Japan
6
Department of Pathology, Hitachi General Hospital, Hitachi, Japan
tuberculous granuloma infiltrating into the aorta. To the best of our knowledge, this is the first reported case of tuberculous aortic involvement detected pre-symptomatically and confirmed pathologically.
Case A 76-year-old non-smoking man with a history of hypertension and colon polyps visited a pulmonologist to undergo follow-up for multiple micronodules that were initially detected by a chest computed tomography (CT) screening (Fig. 1a). During the first visit, he was asymptomatic, and laboratory findings were unremarkable (white blood cell count, 5800/mm 3; C-reactive protein level, 0.12 mg/dL; angiotensin-converting en
Data Loading...
