Perioperative management of a patient with tuberculous destroyed lung and ascending aortic aneurysm undergoing a Bentall procedure: a case report.

BACKGROUND

The coexistence of tuberculous destroyed lung (TDL) and ascending aortic aneurysm represents a rare multimorbidity, posing significant challenges for perioperative management in patients requiring cardiopulmonary bypass (CPB)-assisted major vascular surgery. The clinical manifestations of this polycoexisting disease may be asymptomatic or present as symptoms of one of the diseases or both. Currently, there is no universally accepted diagnostic protocol available for the definitive diagnosis of complex conditions such as tuberculosis and its comorbidities.

CASE PRESENTATION: A 58-year-old woman presented with a 1-month history of cough, expectoration, chest tightness, and dyspnea, which had exacerbated over the preceding week. Pulmonary computed tomography revealed left lung fibrosis with architectural destruction, along with aneurysmal dilation of the ascending aorta. Her medical history included tuberculosis (diagnosed 20 years earlier and treated with anti-tuberculosis therapy for 6 months), hypertension (managed with levamlodipine besylate 5 mg daily), and recurrent pulmonary infections. After multidisciplinary evaluation, she underwent an elective Bentall procedure under CPB. Postoperatively, there was no evidence of tuberculosis reactivation or major complications, and she was discharged after 23 days of hospitalization.

CONCLUSIONS

Successful surgical intervention for TDL combined with thoracic aortic aneurysm is rarely reported. Early diagnosis and timely surgery are critical for improving patient outcomes. This case highlights the importance of multidisciplinary collaboration and customized perioperative strategies in managing such complex multimorbidities.