結核性仮性大動脈瘤を合併した肺結核の1例

A Case of Tuberculous Pseudoaneurysm of the Aorta

要旨

　70歳の糖尿病に罹患している患者が，血痰と発熱で入院した．喀痰検査で抗酸菌染色が陽性で，胸部X線写真では右下葉に3cmの結節影と胸膜肥厚を認めた．胸部CTでは大動脈弓部に大動脈瘤を認めた．入院2日目より抗結核療法を開始した．しかし治療開始後，血痰が認められ，さらに胸部CTで大動脈瘤の増大を認めたため，大動脈瘤の破裂を疑い，大動脈瘤パッチ閉鎖術を行った．瘤壁の結核菌培養が陽性のため，結核性大動脈瘤と判明した．

Summary

　A-70-year-old man with diabetes complaining of hemoptysis and fever was admitted to our hospital. Sputum cultures were positive for Mycobacterium tuberculosis. Chest X-ray films revealed right pleural thickening and a 3-cm nodular shadow in the right lower lobe. Computed tomography scans of the chest revealed an aortic aneurysm at the aortic arch. Antitubercular therapy was started on the second day after admission. After the treatment, chest X-ray films revealed gradual enlargement of the aneurysm, and the patient suffered occasional hemoptysis. An aortic aneurysm with rupture was suspected. He underwent surgery to repair the aneurysm. As culture of the aneurysm wall for acid-fast bacilli was positive, this patient was diagnosed as having a tuberculous aneurysm of the aorta.