Ruptured mycobacterial aneurysm of the carotid artery

Perspect Vasc Surg Endovasc Ther. 2013 Dec;25(3-4):53-6. doi: 10.1177/1531003513512870. Epub 2013 Dec 17.

Abstract

Mycotic aneurysms resulting from intravesical bacillus Calmette-Guérin (BCG) treatment are exceptionally rare. We report on the case of a 73-year-old man who underwent intravesical therapy of BCG for bladder carcinoma and developed a right neck mass. A carotid pseudoaneurysm within a fibrotic mass was noted on surgical exploration. Radical resection was performed followed by a polytetrafluoroethylene interposition graft. Final pathology revealed necrotizing granulomas and multinucleated giant cells concerning for tuberculoma. Intravesicular BCG immunotherapy is an accepted treatment for patients with urothelial carcinoma. Carotid aneurysms are exceptionally rare in this setting and should prompt evaluation for systemic tuberculoid dissemination.

Keywords: aneurysm repair BCG; carotid aneurysm; mycotic; tuberculosis.

Publication types

  • Case Reports

MeSH terms

  • Administration, Intravesical
  • Aged
  • Aneurysm, False / diagnosis
  • Aneurysm, False / microbiology*
  • Aneurysm, False / surgery
  • Aneurysm, Infected / diagnosis
  • Aneurysm, Infected / microbiology*
  • Aneurysm, Infected / surgery
  • Aneurysm, Ruptured / diagnosis
  • Aneurysm, Ruptured / microbiology*
  • Aneurysm, Ruptured / surgery
  • Antineoplastic Agents / administration & dosage
  • Antineoplastic Agents / adverse effects*
  • Antitubercular Agents / therapeutic use
  • BCG Vaccine / administration & dosage
  • BCG Vaccine / adverse effects*
  • Biopsy
  • Blood Vessel Prosthesis
  • Blood Vessel Prosthesis Implantation / instrumentation
  • Carotid Artery Diseases / diagnosis
  • Carotid Artery Diseases / microbiology*
  • Carotid Artery Diseases / surgery
  • Humans
  • Male
  • Polytetrafluoroethylene
  • Prosthesis Design
  • Risk Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Tuberculoma / diagnosis
  • Tuberculoma / microbiology*
  • Tuberculoma / surgery
  • Tuberculosis, Cardiovascular / diagnosis
  • Tuberculosis, Cardiovascular / microbiology*
  • Tuberculosis, Cardiovascular / surgery
  • Urinary Bladder Neoplasms

Substances

  • Antineoplastic Agents
  • Antitubercular Agents
  • BCG Vaccine
  • Polytetrafluoroethylene