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18F-FDG PET/CT of Tuberculosis Meningitis and Carotid Pseudoaneurysm
Kasturi Rangan1, Mudalsha Ravina, Nitin Yadav
1From the Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Abstract:
A 26-year-old woman presented with a headache, left-sided weakness of the body, and pulsatile swelling above the sternal notch. She was treated for abdominal tuberculosis in the past, two years later she developed miliary tuberculosis and was put on modified regimen of antitubercular drugs in view of drug induced hepatitis. Ultrasound neck revealed saccular aneurysm measuring 4 x 3 cm, located in between common carotid arteries with an eccentric thrombus. MRI brain revealed multiple tuberculoma with thick basal meningeal enhancement. Cerebrospinal fluid was positive for Mycobacterium tuberculosis. F-FDG PET/CT was done to delineate the extent of the disease.
Insights
A young woman with a history of tuberculosis developed neurological symptoms and a neck mass. Imaging revealed a carotid artery aneurysm and brain tuberculomas, confirming active Mycobacterium tuberculosis infection.
Area of Science:
- Neurology
- Infectious Diseases
- Vascular Surgery
Background:
- Tuberculosis (TB) can present with diverse extrapulmonary manifestations.
- Disseminated tuberculosis poses diagnostic challenges, especially when involving vascular structures.
- Drug-induced hepatitis necessitates careful regimen modification in TB treatment.
Observation:
- A 26-year-old woman with prior abdominal and miliary tuberculosis presented with headache, hemiparesis, and a pulsatile neck mass.
- Neck ultrasound identified a saccular aneurysm between the common carotid arteries.
- Brain MRI demonstrated multiple tuberculomas and basal meningeal enhancement.
Findings:
- Cerebrospinal fluid analysis confirmed Mycobacterium tuberculosis positivity.
- F-FDG PET/CT imaging was utilized to assess the full extent of the disseminated disease.
- The case highlights a rare association between tuberculosis and carotid artery aneurysm.
Implications:
- This case underscores the importance of considering disseminated tuberculosis in patients with unusual neurological and vascular findings.
- Early and accurate diagnosis is crucial for effective management of complex TB cases.
- Multimodality imaging plays a vital role in delineating the extent of disease and guiding treatment strategies.