Ruptured Tuberculous Aneurysm of the Thoracic Aorta into the Lung: A Case of Successful Surgical Treatment and Literature Review

結核菌動脈瘤破裂後的肺侵犯：一成功外科切除病例及文獻回顧

陸希平(Shi-Ping Luh) ； 余榮敏(Jung-Min Yu) ； 蔡宗博(Tsong-Po Tsai) ； 周明智(Ming-Chih Chou)

《中山醫學雜誌》 14卷4期 (2003/12) Pp. 581-586

https://doi.org/10.30096/CSMJ.200312.0011

摘要

結核菌動脈瘤雖然不常見，但是一旦發生，如果不及時處理，常會產生嚴重致命的後遺症。動脈瘤破裂後侵犯到肺部的情況，在過去偶有病例報告，但成功治療的機率很低。在此我們報告一82歲男性，因結核菌感染造成假性動脈瘤並且侵犯至左肺上葉，以致大量咳血送醫．這位病人在接受成功的外科切除及修復手術後平安出院，經過追蹤24個月後情況良好。根據過去文獻探討以及個人的經驗，我們歸納如下：1.對於可疑的病人需要注意其可能性。2.對於疑似病人必須避免作侵襲性檢查，以免造成致命性的大出血。3.完全切除病灶是成功治療之決定要件。4.抗結核藥物治療在術後必須及早開始，並持續至少6個月，如此可防止未來疾病再發。

關鍵字

結核病 ； 動脈瘤

並列摘要

Even though tuberculous aneurysm of the aorta is not common, it might be fatal if left untreated, since rupture and loss of blood will usually occur. Perforation into the lung parenchyma is even rarer and in cases in it happens the patients die without surgical intervention. Herein, we report on an 82 year-old male, who had massive hemoptysis due to the rupture of a tuberculous aneurysm into the left upper lobe of the lung. The patient underwent successful surgical resection and he was found to be in generally good condition of the time of his 24-month follow-up. When the patient had come in, we used our own experience and review of previous literature to conclude the following . (1) Clinical suspicion, early detection and surgical intervention was the only way
for a patient with ruptured tuberculous aneurysm to survive. (2) Invasive procedures, such as transbronchial or thoracoscopic biopsy, should be avoided because fatal bleeding will occur. (3) Complete resection and rconstruction of the diseased aorta is mandatory. (4) Antituberculosis chemotherapy should be initiated as early as possible and continued for at least 6 months, if recurrence is to be prevented.

並列關鍵字

tuberculosis ； aneurysm