Aortic thrombus in pulmonary tuberculosis: a rare case report

• Main Authors: Krishna Bihari Gupta, Abhishek Tandon, Vipul Kumar, Vishal Raj, Adarsh Shetty, Azad Singh
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2019-01-01
• Series: Egyptian Journal of Chest Disease and Tuberculosis
• Subjects: aortic thrombus; pulmonary tuberculosis; thromboembolism
• Online Access: http://www.ejcdt.eg.net/article.asp?issn=0422-7638;year=2019;volume=68;issue=4;spage=624;epage=626;aulast=Gupta
• ISSN: 0422-7638; 2090-9950

Tuberculosis in the past decade has emerged to be a risk factor for the development of venous thrombo-embolism. However, its association with arterial thrombosis is rare. We present a case of thrombus of the distal arch of aorta in a patient with pulmonary tuberculosis. To the best of our knowledge, this is the first reported case of its kind. A 46-year-old male, reformed smoker, with history of multiple antitubercular therapy intake presented to the Emergency Department of PGIMS Rohtak with shortness of breath for 1 month, cough with expectoration for 15 days, fever and generalized itching over the body for 7 days, and inability to speak since 2 days. A Contrast Enhanced Computed Tomography scan (CECT) of neck and thorax was done, which revealed a large ovoid hypodensity in the distal arch of aorta causing 70–80% luminal narrowing, suggestive of a thrombus. To further evaluate the hypodensity, a Computed Tomography Pulmonary Angiography (CTPA) was done, which revealed a moderate (40–50%) luminal narrowing in distal aortic arch of descending thoracic aorta, with no obvious pulmonary thromboembolism. His leukocytic count was 34 000 (86|10|2|2), was hepatitis C positive, Prothrombin Time (PT)|International Normalised Ratio (INR) was 14.6|1.08, d-dimer was 10.00 (normal<0.5), had complete paralysis of the left vocal cord, and sputum Acid Fast Bacilli (AFB) was 3+. In our patient, absence of any risk factor, comorbidity and family history of coagulation disorder points to the underlying tuberculosis as the most possible cause of the aortic thrombus. We hope that in view of this case report, studies that aim to find a causal relationship between tuberculosis and arterial thrombus are.