TEVAR for Tuberculous Mycotic Thoracic Aortic Aneurysm after Intravesical Instillations of BCG Therapy

Abstract

A 79-year-old man, who had a history of intravesical instillations of bacillus Calmette-Guérin (BCG) therapy for urinary bladder cancer, developed bloody sputum 4 years after BCG therapy. BCG was detected from the sputum by detailed examination. Medical therapy for tuberculosis (TB) was started, but bloody sputum continued. Computed tomography (CT) for the chest was performed to evaluate the state of TB, and surprisingly, found impending rupture of tuberculosis mycotic thoracic aneurysm. He was emergently transferred to our hospital. CT revealed that the aneurysm made a lump with surrounding lung and lymph nodes. It seemed to be quite difficult to dissect and to be quite high risk to perform graft replacement with pneumonectomy. On the other hand, TB infection was controlled with antibiotic therapy. Thus we chose debranch TEVAR for this complicated situation. His bloody sputum regressed soon after the procedure and disappeared during his hospitalization. He was discharged home on POD 13 without serious complication and continued to have antibiotic therapy under the instruction of his primary physician.