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Kim M, Han JH, Choi JB, Lee BC, Jung HJ. Case Report: Superior mesenteric artery vasculitis causing aneurysm following COVID-19 infection. Front Surg 2024; 11:1394638. [PMID: 39233764 PMCID: PMC11371763 DOI: 10.3389/fsurg.2024.1394638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 08/02/2024] [Indexed: 09/06/2024] Open
Abstract
Objective Arteritis refers to all infectious and non-infectious conditions that lead to inflammation of the arterial wall. However, little is known about its presence in patients with coronavirus disease 2019 (COVID-19). Most patients improved with steroids along with conservative treatments in a few studies. We report our experience with superior mesenteric artery (SMA) arteritis causing an aneurysm following COVID-19 infection. Case presentation A 66-year-old female patient who was infected with COVID-19 1 month prior presented with abdominal pain. A computed tomography scan revealed proximal SMA arteritis. Although preliminary antibacterial treatment was initiated, the follow-up CT revealed an aggressive and fast-growing 5.7-cm SMA aneurysm. Subsequently, an open interposition bypass of the SMA aneurysm was performed successfully. As the specimens retrieved during surgery showed no bacterial colonization in the tissue or blood cultures, the patient was discharged without complications. Conclusions The mechanism of arteritis in patients with COVID-19 has not been elucidated. In the absence of evidence of bacterial infection in arteritis, it is necessary to consider the possibility of viral infection caused by COVID-19 during the COVID-19 pandemic era and start with high-dose steroid therapy promptly.
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Affiliation(s)
- Minju Kim
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Jeong Hee Han
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Jung Bum Choi
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Byoung Chul Lee
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Hyuk Jae Jung
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
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2
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Orellana Davila B, Mancusi C, Coscarella C, Spataro C, Carfagna P, Ippoliti A, Giudice R, Ferrer C. Urgent or Emergent Endovascular Aortic Repair of Infective Aortitis. J Clin Med 2024; 13:4669. [PMID: 39200812 PMCID: PMC11354867 DOI: 10.3390/jcm13164669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 07/31/2024] [Accepted: 08/07/2024] [Indexed: 09/02/2024] Open
Abstract
Background: Aortitis is a rare inflammation of the aorta. It can be classified as infective, non-infective, or idiopathic. Infective aortitis can debut as an acute aortic syndrome that needs urgent or emergent treatment. Historically, these kinds of patients have been preferably treated by open surgery, with subsequent lack of information about the endovascular repair. The aim of the present study is to report the results of our experience with the urgent or emergent endovascular repair of infective aortitis with acute presentation. Methods: All consecutive urgent or emergent endovascular repairs, performed between January 2019 and January 2024 for the treatment of infective aortitis, were included. The inclusion criteria were clinical, laboratory, and radiological findings recognized as aortitis risk factors. Patients with graft or endograft infection, aortic fistulae, and mycotic aneurysm were excluded. Primary endpoints were technical success and 30-day and follow-up survival. Early and late major adverse events, any changes in lesion morphology over time, and need for re-intervention were also assessed. Results: A total of 15 patients (14 males and 1 female) with a mean age of 74.2 ± 8.3 were included. All the subjects were treated by endovascular means in an urgent or emergent setting because of a rapidly growing aneurysm, symptomatic lesion, or contained or free aortic rupture. The diagnosis of infective aortitis was confirmed postoperatively by positive blood cultures in all the patients. A rapidly growing or symptomatic lesion was noted in all 15 subjects. Among these there were six (40%) contained and two (13%) free aneurysm ruptures. The endovascular techniques performed were as follows: four thoracic-EVAR (TEVAR), three off-the-shelf branched-EVAR (BEVAR), one Chimney-EVAR (Ch-EVAR), six EVAR with bifurcated graft, and one EVAR with straight tube graft. Technical success was achieved in 100% of the patients. Two patients (13%) died within 30 days after the index procedure. No case of early aortic-related mortality was registered. During a mean follow-up of 31.6 ± 23.1 months (range 1-71), no further death or major adverse event was registered among the remaining 13 alive patients. Re-interventions were performed in three cases (20%). Aneurysm's shrinkage > 5 mm or stability was noted in 10 of the 13 patients who survived the early period after repair. Conclusions: Despite the relative reluctance to use an endograft in an infected area, in our experience the endovascular approach resulted to be feasible, safe, and effective in the treatment of infective aortitis with acute presentation, with acceptable peri-operative and mid-term follow-up outcomes. Further studies are needed to confirm our results.
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Affiliation(s)
- Bernardo Orellana Davila
- Vascular and Endovascular Surgery Unit, San Giovanni-Addolorata Hospital, 00184 Rome, Italy; (B.O.D.); (C.M.); (C.C.); (C.S.); (R.G.)
| | - Carlotta Mancusi
- Vascular and Endovascular Surgery Unit, San Giovanni-Addolorata Hospital, 00184 Rome, Italy; (B.O.D.); (C.M.); (C.C.); (C.S.); (R.G.)
| | - Carlo Coscarella
- Vascular and Endovascular Surgery Unit, San Giovanni-Addolorata Hospital, 00184 Rome, Italy; (B.O.D.); (C.M.); (C.C.); (C.S.); (R.G.)
| | - Claudio Spataro
- Vascular and Endovascular Surgery Unit, San Giovanni-Addolorata Hospital, 00184 Rome, Italy; (B.O.D.); (C.M.); (C.C.); (C.S.); (R.G.)
| | - Paolo Carfagna
- Clinical Medicine and Infectious Diseases Unit, San Giovanni-Addolorata Hospital, 00184 Rome, Italy;
| | - Arnaldo Ippoliti
- Vascular Surgery Unit, Biomedicine and Prevention Department, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Rocco Giudice
- Vascular and Endovascular Surgery Unit, San Giovanni-Addolorata Hospital, 00184 Rome, Italy; (B.O.D.); (C.M.); (C.C.); (C.S.); (R.G.)
| | - Ciro Ferrer
- Vascular and Endovascular Surgery Unit, San Giovanni-Addolorata Hospital, 00184 Rome, Italy; (B.O.D.); (C.M.); (C.C.); (C.S.); (R.G.)
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3
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Espitia O, Toquet C, Jamet B, Serfaty JM, Agard C. [Aortitis]. Rev Med Interne 2024:S0248-8663(24)00674-X. [PMID: 39034261 DOI: 10.1016/j.revmed.2024.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/23/2024] [Accepted: 06/26/2024] [Indexed: 07/23/2024]
Abstract
Aortitis is a rare disease entity of unknown prevalence. Primary aortitis mainly affects the thoracic aorta. They are most often diagnosed on imaging by grade III 18-FDG uptake of the aortic wall on PET, or by circumferential thickening>2.2mm on CT or MRI with late-stage contrast. More rarely, aortitis is histologically proven, as in some cases of clinically isolated aortitis discovered after planned aortic aneurysm surgery or during aortic dissection surgery. The most common histological types are granulomatous/giant cell or lymphoplasmacytic. Clinical signs associated with aortitis are often non-specific: asthenia, fever, dry cough, chest, back, lumbar or abdominal pain. Aortitis can be divided into different etiological categories: primary aortitis, which includes vasculitis with a preferential or exclusive tropism for the aortic wall, aortitis secondary to systemic or iatrogenic diseases, and infectious aortitis. The main etiologies of primary aortitis are giant cell arteritis (GCA), Takayasu arteritis (TA) or clinically isolated aortitis. Aortitis secondary to systemic diseases is seen in atrophying polychondritis, systemic lupus and inflammatory rheumatic diseases such as spondyloarthropathy and rheumatoid arthritis. In both ACG and AT, aortitis is a negative factor, characterized by a higher risk of relapse, cardiovascular complications and increased mortality. The management of aortitis is insufficiently codified, and relies on the control of cardiovascular risk factors, with particular monitoring of blood pressure and LDL cholesterol, and on corticosteroid therapy and immunosuppressive drugs, the use of which will depend on the disease associated with the aortitis, the initial severity and comorbidities.
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Affiliation(s)
- Olivier Espitia
- Inserm UMR1087/CNRS UMR 6291, Team III Vascular & Pulmonary Diseases, Service de Médecine Interne et Vasculaire, Institut du Thorax, Nantes Université, CHU de Nantes, 44000 Nantes, France.
| | - Claire Toquet
- Inserm UMR1087/CNRS UMR 6291, service d'anatomopathologie, institut du thorax, Nantes université, CHU de Nantes, 44000 Nantes, France
| | - Bastien Jamet
- CNRS, Inserm, CRCINA, service de médecine nucléaire, Nantes université, CHU de Nantes, 44000 Nantes, France
| | - Jean-Michel Serfaty
- Inserm UMR1087/CNRS UMR 6291, service de radiologie cardiaque et vasculaire, institut du thorax, Nantes université, CHU de Nantes, 44000 Nantes, France
| | - Christian Agard
- Service de médecine interne, Nantes université, CHU de Nantes, 44000 Nantes, France
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4
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Czerny M, Grabenwöger M, Berger T, Aboyans V, Della Corte A, Chen EP, Desai ND, Dumfarth J, Elefteriades JA, Etz CD, Kim KM, Kreibich M, Lescan M, Di Marco L, Martens A, Mestres CA, Milojevic M, Nienaber CA, Piffaretti G, Preventza O, Quintana E, Rylski B, Schlett CL, Schoenhoff F, Trimarchi S, Tsagakis K, Siepe M, Estrera AL, Bavaria JE, Pacini D, Okita Y, Evangelista A, Harrington KB, Kachroo P, Hughes GC. EACTS/STS Guidelines for Diagnosing and Treating Acute and Chronic Syndromes of the Aortic Organ. Ann Thorac Surg 2024; 118:5-115. [PMID: 38416090 DOI: 10.1016/j.athoracsur.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Affiliation(s)
- Martin Czerny
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany.
| | - Martin Grabenwöger
- Department of Cardiovascular Surgery, Clinic Floridsdorf, Vienna, Austria; Medical Faculty, Sigmund Freud Private University, Vienna, Austria.
| | - Tim Berger
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, Limoges, France; EpiMaCT, Inserm 1094 & IRD 270, Limoges University, Limoges, France
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy; Cardiac Surgery Unit, Monaldi Hospital, Naples, Italy
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Julia Dumfarth
- University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - John A Elefteriades
- Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
| | - Christian D Etz
- Department of Cardiac Surgery, University Medicine Rostock, University of Rostock, Rostock, Germany
| | - Karen M Kim
- Division of Cardiovascular and Thoracic Surgery, The University of Texas at Austin/Dell Medical School, Austin, Texas
| | - Maximilian Kreibich
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, University Medical Centre Tübingen, Tübingen, Germany
| | - Luca Di Marco
- Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andreas Martens
- Department of Cardiac Surgery, Klinikum Oldenburg, Oldenburg, Germany; The Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Carlos A Mestres
- Department of Cardiothoracic Surgery and the Robert WM Frater Cardiovascular Research Centre, The University of the Free State, Bloemfontein, South Africa
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Christoph A Nienaber
- Division of Cardiology at the Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Gabriele Piffaretti
- Vascular Surgery Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Bartosz Rylski
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Christopher L Schlett
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany; Department of Diagnostic and Interventional Radiology, University Hospital Freiburg, Freiburg, Germany
| | - Florian Schoenhoff
- Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Santi Trimarchi
- Department of Cardiac Thoracic and Vascular Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Medicine Essen, Essen, Germany
| | - Matthias Siepe
- EACTS Review Coordinator; Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Anthony L Estrera
- STS Review Coordinator; Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth Houston, Houston, Texas
| | - Joseph E Bavaria
- Department of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Davide Pacini
- Division of Cardiac Surgery, S. Orsola University Hospital, IRCCS Bologna, Bologna, Italy
| | - Yutaka Okita
- Cardio-Aortic Center, Takatsuki General Hospital, Osaka, Japan
| | - Arturo Evangelista
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Institut de Recerca, Barcelona, Spain; Biomedical Research Networking Center on Cardiovascular Diseases, Instituto de Salud Carlos III, Madrid, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; Instituto del Corazón, Quirónsalud-Teknon, Barcelona, Spain
| | - Katherine B Harrington
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - Puja Kachroo
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Missouri
| | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Duke University, Durham, North Carolina
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5
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De Gaspari M, Ascione A, Baldovini C, Marzullo A, Pucci A, Rizzo S, Salzillo C, Angelini A, Basso C, d’Amati G, di Gioia CRT, van der Wal AC, Giordano C. Cardiovascular pathology in vasculitis. Pathologica 2024; 116:78-92. [PMID: 38767541 PMCID: PMC11138763 DOI: 10.32074/1591-951x-993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 05/22/2024] Open
Abstract
Vasculitides are diseases that can affect any vessel. When cardiac or aortic involvement is present, the prognosis can worsen significantly. Pathological assessment often plays a key role in reaching a definite diagnosis of cardiac or aortic vasculitis, particularly when the clinical evidence of a systemic inflammatory disease is missing. The following review will focus on the main histopathological findings of cardiac and aortic vasculitides.
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Affiliation(s)
- Monica De Gaspari
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Azienda Ospedaliera, Padova, Italy
| | - Andrea Ascione
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Chiara Baldovini
- Department of Pathology, Cardiovascular and Cardiac Transplant Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Marzullo
- Department of Precision and Regenerative Medicine and Ionian Area, Pathology Unit, University of Bari “Aldo Moro”, Bari, Italy
| | - Angela Pucci
- Histopathology Department, University Hospital of Pisa, Pisa, Italy
| | - Stefania Rizzo
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Azienda Ospedaliera, Padova, Italy
| | - Cecilia Salzillo
- Department of Precision and Regenerative Medicine and Ionian Area, Pathology Unit, University of Bari “Aldo Moro”, Bari, Italy
| | - Annalisa Angelini
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Azienda Ospedaliera, Padova, Italy
| | - Cristina Basso
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Azienda Ospedaliera, Padova, Italy
| | - Giulia d’Amati
- Department of Radiology, Oncology and Pathology, Sapienza University, Rome, Italy
| | | | - Allard C. van der Wal
- Department of Pathology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Carla Giordano
- Department of Radiology, Oncology and Pathology, Sapienza University, Rome, Italy
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6
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Czerny M, Grabenwöger M, Berger T, Aboyans V, Della Corte A, Chen EP, Desai ND, Dumfarth J, Elefteriades JA, Etz CD, Kim KM, Kreibich M, Lescan M, Di Marco L, Martens A, Mestres CA, Milojevic M, Nienaber CA, Piffaretti G, Preventza O, Quintana E, Rylski B, Schlett CL, Schoenhoff F, Trimarchi S, Tsagakis K. EACTS/STS Guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ. Eur J Cardiothorac Surg 2024; 65:ezad426. [PMID: 38408364 DOI: 10.1093/ejcts/ezad426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/15/2023] [Accepted: 12/19/2023] [Indexed: 02/28/2024] Open
Affiliation(s)
- Martin Czerny
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Martin Grabenwöger
- Department of Cardiovascular Surgery, Clinic Floridsdorf, Vienna, Austria
- Medical Faculty, Sigmund Freud Private University, Vienna, Austria
| | - Tim Berger
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, Limoges, France
- EpiMaCT, Inserm 1094 & IRD 270, Limoges University, Limoges, France
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
- Cardiac Surgery Unit, Monaldi Hospital, Naples, Italy
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Julia Dumfarth
- University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - John A Elefteriades
- Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - Christian D Etz
- Department of Cardiac Surgery, University Medicine Rostock, University of Rostock, Rostock, Germany
| | - Karen M Kim
- Division of Cardiovascular and Thoracic Surgery, The University of Texas at Austin/Dell Medical School, Austin, TX, USA
| | - Maximilian Kreibich
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, University Medical Centre Tübingen, Tübingen, Germany
| | - Luca Di Marco
- Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andreas Martens
- Department of Cardiac Surgery, Klinikum Oldenburg, Oldenburg, Germany
- The Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Carlos A Mestres
- Department of Cardiothoracic Surgery and the Robert WM Frater Cardiovascular Research Centre, The University of the Free State, Bloemfontein, South Africa
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Christoph A Nienaber
- Division of Cardiology at the Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Gabriele Piffaretti
- Vascular Surgery Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Bartosz Rylski
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Christopher L Schlett
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Freiburg, Freiburg, Germany
| | - Florian Schoenhoff
- Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Santi Trimarchi
- Department of Cardiac Thoracic and Vascular Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Medicine Essen, Essen, Germany
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7
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Carrer M, Vignals C, Berard X, Caradu C, Battut AS, Stenson K, Neau D, Lazaro E, Mehlen M, Barret A, Nyamankolly E, Lifermann F, Rispal P, Illes G, Rouanes N, Caubet O, Poirot-Mazeres S, Vareil MO, Alleman L, Millon A, Huvelle U, Valour F, Ferry T, Cazanave C, Puges M. Retrospective Multicenter Study Comparing Infectious and Noninfectious Aortitis. Clin Infect Dis 2023; 76:e1369-e1378. [PMID: 35792621 DOI: 10.1093/cid/ciac560] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 06/27/2022] [Accepted: 07/01/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Determining the etiology of aortitis is often challenging, in particular to distinguish infectious aortitis (IA) and noninfectious aortitis (NIA). This study aims to describe and compare the clinical, biological, and radiological characteristics of IA and NIA and their outcomes. METHODS A multicenter retrospective study was performed in 10 French centers, including patients with aortitis between 1 January 2014 and 31 December 2019. RESULTS One hundred eighty-three patients were included. Of these, 66 had IA (36.1%); the causative organism was Enterobacterales and streptococci in 18.2% each, Staphylococcus aureus in 13.6%, and Coxiella burnetii in 10.6%. NIA was diagnosed in 117 patients (63.9%), mainly due to vasculitides (49.6%), followed by idiopathic aortitis (39.3%). IA was more frequently associated with aortic aneurysms compared with NIA (78.8% vs 17.6%, P < .001), especially located in the abdominal aorta (69.7% vs 23.1%, P < .001). Crude and adjusted survival were significantly lower in IA compared to NIA (P < .001 and P = .006, respectively). In the IA cohort, high American Society of Anesthesiologists score (hazard ratio [HR], 2.47 [95% confidence interval {CI}, 1.08-5.66]; P = .033) and free aneurysm rupture (HR, 9.54 [95% CI, 1.04-87.11]; P = .046) were significantly associated with mortality after adjusting for age, sex, and Charlson comorbidity score. Effective empiric antimicrobial therapy, initiated before any microbial documentation, was associated with a decreased mortality (HR, 0.23, 95% CI, .08-.71]; P = .01). CONCLUSIONS IA was complicated by significantly higher mortality rates compared with NIA. An appropriate initial antibiotic therapy appeared as a protective factor in IA.
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Affiliation(s)
- Mathilde Carrer
- Infectious and Tropical Diseases Department, Centre hospitalier universitaire Bordeaux, Bordeaux, France
| | - Carole Vignals
- Infectious and Tropical Diseases Department, Centre hospitalier universitaire Bordeaux, Bordeaux, France
| | - Xavier Berard
- Department of Vascular Surgery, Centre hospitalier universitaire Bordeaux, Bordeaux, France
| | - Caroline Caradu
- Department of Vascular Surgery, Centre hospitalier universitaire Bordeaux, Bordeaux, France
| | - Anne-Sophie Battut
- Department of Vascular Surgery, Clinique Mutualiste de Pessac, Pessac, France
| | - Katherine Stenson
- St George's University Hospitals NHS Foundation Trust, Imperial College Healthcare, London, United Kingdom
| | - Didier Neau
- Infectious and Tropical Diseases Department, Centre hospitalier universitaire Bordeaux, Bordeaux, France
| | - Estibaliz Lazaro
- Internal Medicine and Infectious Disease Department, Centre hospitalier universitaire Bordeaux, Bordeaux, France
| | - Maxime Mehlen
- Infectious and Tropical Diseases Department, Centre hospitalier universitaire Bordeaux, Bordeaux, France
| | - Amaury Barret
- Internal Medicine and Infectious Diseases Department, Centre hospitalier Arcachon, Arcachon, France
| | - Elsa Nyamankolly
- Infectious and Tropical Diseases Department, Centre hospitalier Dax, Dax, France
| | | | - Patrick Rispal
- Infectious and Tropical Diseases Department, Centre hospitalier Agen, Agen, France
| | - Gabriela Illes
- Infectious and Tropical Diseases Department, Centre hospitalier Mont de Marsan, Mont de Marsan, France
| | - Nicolas Rouanes
- Polyvalent Medicine Department, Centre hospitalier Périgueux, Périgueux, France
| | - Olivier Caubet
- Internal Medicine Department, Centre hospitalier Libourne, Libourne, France
| | | | - Marc-Olivier Vareil
- Infectious and Tropical Diseases Department, Centre hospitalier Bayonne, Bayonne, France
| | - Laure Alleman
- Infectious and Tropical Diseases Department, Centre hospitalier Bayonne, Bayonne, France
| | - Antoine Millon
- Department of Vascular Surgery, Centre hospitalier universitaire Lyon, Lyon, France
| | - Ugo Huvelle
- Department of Vascular Surgery, Centre hospitalier universitaire Lyon, Lyon, France
| | - Florent Valour
- Infectious and Tropical Diseases Department, Centre hospitalier universitaire Lyon, Lyon, France
| | - Tristan Ferry
- Infectious and Tropical Diseases Department, Centre hospitalier universitaire Lyon, Lyon, France
| | - Charles Cazanave
- Infectious and Tropical Diseases Department, Centre hospitalier universitaire Bordeaux, Bordeaux, France
| | - Mathilde Puges
- Infectious and Tropical Diseases Department, Centre hospitalier universitaire Bordeaux, Bordeaux, France
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8
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Mirzamidinov D, Karauzum K, Kahraman N, Cakir O, Karauzum I, Ural E, Sahin T. A successful endovascular treatment of a patient with extended-spectrum beta-lactamase positive Escherichia coli related emphysematous distal abdominal aortitis rapidly progressing to a saccular aneursym. J Cardiol Cases 2023; 27:215-217. [PMID: 37180213 PMCID: PMC10173396 DOI: 10.1016/j.jccase.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/14/2022] [Accepted: 01/13/2023] [Indexed: 02/16/2023] Open
Abstract
Infectious aortitis is a rare disease and associated with adverse clinical outcomes. A 66-year-old man was admitted to the emergency department with abdominal and lower back pain, fever, chills, and anorexia continuing for a week. A contrast-enhanced computed tomography (CT) scan of the abdomen showed multiple periaortic enlarged lymphatic nodes, mural wall thickening, and gas collections in the infrarenal aorta and proximal segment of right common iliac artery. The patient was hospitalized with the diagnosis of acute emphysematous aortitis. During hospitalization, extended-spectrum beta-lactamase-positive Escherichia coli was grown in all blood and urine cultures. Despite sensitive antibiotherapy, abdominal and back pain, inflammation biomarkers, and fever of the patient were not improved. Control CT demonstrated a newly developed mycotic aneurysm, increased intramural gas collection, and periaortic soft-tissue thickening. Urgent vascular surgery was recommended to the patient by the heart team, but the patient rejected surgery due to the high perioperative risk. Alternatively, an endovascular rifampin-impregnated stent-graft was successfully implanted and antibiotics were completed at 8 weeks. After procedure, inflammatory indicators were normalized and clinical symptoms of the patient were resolved. No microorganism grew on control blood and urine cultures. The patient was discharged with a good health. Learning objective Aortitis should be suspected in patients who present with fever, abdominal and back pain, especially in the presence of predisposing risk factors. Infectious aortitis (IA) accounts for a small part of all aortitis cases and the most common causative microorganism is Salmonella. The mainstay treatment of IA is sensitive antibiotherapy. Surgery may be required in patients who are unresponsive to antibiotics or develop aneurysm. Alternatively, endovascular treatment can be performed in selected cases.
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9
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Bugenhagen SM, Raptis DA, Bhalla S. Vascular Infections in the Thorax. Semin Roentgenol 2022; 57:380-394. [DOI: 10.1053/j.ro.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/29/2022] [Accepted: 07/02/2022] [Indexed: 11/11/2022]
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10
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Abdelazeem B, Kambalapalli S, Lahmar A, Yousaf A, Kusz H. Infectious Aortitis: Case Report and Literature Review. Cureus 2022; 14:e23198. [PMID: 35444907 PMCID: PMC9010422 DOI: 10.7759/cureus.23198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 11/07/2022] Open
Abstract
Aortitis is the inflammation of the aorta secondary to either infectious or non-infectious etiologies. Infectious aortitis is a rare but potentially life-threatening condition. It is more common among older patients with preexisting pathology. Clinical presentation is variable, therefore, a high index of suspicion is required for timely diagnosis and management. We report a case of aortitis which was complicated with the development of a saccular abdominal aortic aneurysm. A 76-year-old male presented to the Emergency Department with two days of right lower quadrant abdominal pain. Clinical evaluation and imaging studies revealed abdominal aortitis, which progressed to a saccular abdominal aortic aneurysm. We highlight a unique presentation of infectious aortitis to raise awareness among physicians. We also reviewed the available literature on infectious aortitis to illustrate the importance of early diagnosis and appropriate treatment to improve the patients' outcomes.
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11
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Tardif I, Muravia M, Mousa MS, Sirotkin I. Emphysematous Aortitis due to Klebsiella Pneumoniae in a Patient With Poorly Controlled Diabetes Mellitus. Fed Pract 2022; 38:e72-e76. [PMID: 35136344 DOI: 10.12788/fp.0202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Patients with poorly controlled diabetes mellitus and an infectious source can be predisposed to infectious aortitis.
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Affiliation(s)
- Irina Tardif
- University of Central Florida College of Medicine, Orlando
| | - Mariya Muravia
- University of Central Florida College of Medicine, Orlando
| | - Mina S Mousa
- Mallinckrodt Institute of Radiology, Washington Unviersity School of Medicine, St. Louis, Missouri
| | - Igor Sirotkin
- University of South Florida, Tampa.,Bay Pines Veterans Affairs Healthcare System, Florida
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12
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Ganchinho Lucas S, Alfaiate F, Santos I, Rocha R, Lino I. Aortitis as a Harbinger of Esophageal Cancer. Cureus 2021; 13:e20065. [PMID: 34987933 PMCID: PMC8718965 DOI: 10.7759/cureus.20065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2021] [Indexed: 11/06/2022] Open
Abstract
Aortitis is a rare diagnosis that requires a high index of suspicion due to nonspecific symptoms and its multiplicity of etiologies. An 80-year-old man, independent in activities of daily living (ADLs), had three consecutive hospitalizations in three months for fever, general malaise, anorexia associated with arthritis of the hands and feet with the inability to walk. Inflammatory markers were increased without a focus of infection identified. Upper digestive endoscopy (UDE), colonoscopy, blood cultures, thoracoabdominal-pelvic CT and transthoracic (TT) echocardiogram were performed without changes, with discharge for consultation after demonstrating apyrexia. At the patient second hospitalization for fever and arthritis, a transesophageal echocardiogram was performed that showed the presence of multiple complex atherosclerotic plaques, with associated thrombi in all segments of the aorta with a suspicious mass of vegetation on the aorta. Thoracic-abdominopelvic CT demonstrated calcified atheromatosis of the entire aorta with para-aortic nodes; MRI showed aortic thickening; and autoimmunity study was negative. Aortitis was the working diagnosis of possible infectious etiology and anticoagulation and antibiotic therapy were started. Fever recurred and a third admission led to a working diagnosis of inflammatory, non-infectious aortitis. The patient responded well to empiric corticosteroids. The patient followed up in consultation, remained asymptomatic under a low dose of corticosteroids with negative temporal artery biopsy. In the sixth month, he repeated UDE due to dysphagia, which showed the presence of esophageal neoformation with the histological diagnosis of squamous cell carcinoma, maintaining on the CT as alterations in the aorta. This is an unusual case of aortitis associated with arthritis with improvement after corticosteroids, which interestingly occurred before the progression of esophageal cancer. In hindsight, we think this may have been a large vessel paraneoplastic vasculitis that preceded the detection of esophageal squamous cell carcinoma.
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13
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Shchetynska-Marinova T, Amendt K, Sadick M, Keese M, Sigl M. Aortitis - An Interdisciplinary Challenge. In Vivo 2021; 35:41-52. [PMID: 33402448 DOI: 10.21873/invivo.12230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 10/15/2020] [Accepted: 10/21/2020] [Indexed: 12/24/2022]
Abstract
The term 'aortitis' comprises a heterogeneous spectrum of diseases, with varied etiology and clinical presentations, whose common characteristic is the inflammation of the aortic wall. Since aortitis can mimic almost all common cardiovascular disorders, its clinical recognition remains a challenge. Some cases of aortitis remain undetected for a long time and may be diagnosed after severe life-threatening complications have already arisen. The diagnosis of aortitis is based on the presence of homogeneous circumferential thickening of the aortic wall detected on aortic imaging, or typical histological features in combination with clinical findings and laboratory parameters. Management of aortitis is usually conservative (immunosuppressive drugs in noninfectious aortitis; antimicrobial drugs in infectious). However, if vascular complications such as aortic aneurysm, rupture, or steno-occlusive events appear, aortic surgery or endovascular therapy may be required. This review article summarizes the current knowledge regarding the etiology, clinical presentation, diagnosis, and treatment of inflammatory diseases of the aorta to promote better clinical management of these entities.
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Affiliation(s)
- Tetyana Shchetynska-Marinova
- First Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Klaus Amendt
- Vascular Center Oberrhein, Internal Medicine I, Diakonissenkrankenhaus Mannheim, Mannheim, Germany
| | - Maliha Sadick
- Clinic for Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael Keese
- Department of Vascular Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Martin Sigl
- First Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany;
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14
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Dua A, Sutphin PD, Siedner MJ, Moran J. Case 16-2021: A 37-Year-Old Woman with Abdominal Pain and Aortic Dilatation. N Engl J Med 2021; 384:2054-2063. [PMID: 34042393 DOI: 10.1056/nejmcpc2100278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Anahita Dua
- From the Departments of Surgery (A.D.), Radiology (P.D.S.), Medicine (M.J.S.), and Pathology (J.M.), Massachusetts General Hospital, and the Departments of Surgery (A.D.), Radiology (P.D.S.), Medicine (M.J.S.), and Pathology (J.M.), Harvard Medical School - both in Boston
| | - Patrick D Sutphin
- From the Departments of Surgery (A.D.), Radiology (P.D.S.), Medicine (M.J.S.), and Pathology (J.M.), Massachusetts General Hospital, and the Departments of Surgery (A.D.), Radiology (P.D.S.), Medicine (M.J.S.), and Pathology (J.M.), Harvard Medical School - both in Boston
| | - Mark J Siedner
- From the Departments of Surgery (A.D.), Radiology (P.D.S.), Medicine (M.J.S.), and Pathology (J.M.), Massachusetts General Hospital, and the Departments of Surgery (A.D.), Radiology (P.D.S.), Medicine (M.J.S.), and Pathology (J.M.), Harvard Medical School - both in Boston
| | - Jakob Moran
- From the Departments of Surgery (A.D.), Radiology (P.D.S.), Medicine (M.J.S.), and Pathology (J.M.), Massachusetts General Hospital, and the Departments of Surgery (A.D.), Radiology (P.D.S.), Medicine (M.J.S.), and Pathology (J.M.), Harvard Medical School - both in Boston
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15
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Eke UA, Doub JB, Chua JV. Campylobacter fetus aortitis in a patient with HIV. IDCases 2021; 25:e01169. [PMID: 34094867 PMCID: PMC8167207 DOI: 10.1016/j.idcr.2021.e01169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 02/07/2023] Open
Abstract
A 36-year-old man with well controlled HIV developed Campylobacter fetus aortitis. To prevent aortic rupture, emergent surgical resection and neo-aortoiliac replacement with his left femoral vein was conducted. After surgical intervention, he was successfully treated with intravenous ertapenem for 6 weeks followed by oral amoxicillin for 3 months.
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Affiliation(s)
- Uzoamaka A Eke
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - James B Doub
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Joel V Chua
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
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16
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El Yaagoubi Y, Prunier-Aesch C, Chetanneau A, Philippe L, Bleuet F, Menard E, Doll G. 18F-FDG PET/CT Detection of a Popliteal Mycotic Aneurysm Complicating Staphylococcus aureus Bacteremia. Clin Nucl Med 2021; 46:411-412. [PMID: 33630810 DOI: 10.1097/rlu.0000000000003562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT A 75-year-old man presented with Staphylococcus aureus bacteremia, fever, and right posterior knee pain. Venous Doppler ultrasound of the lower extremity showed an isolated right calf muscle vein thrombosis, without any sign of deep vein thrombosis. 18F-FDG PET/CT revealed an intense focal uptake on the right popliteal artery, suggesting a mycotic aneurysm (MA). Lower limb CT angiography confirmed an MA of the right popliteal artery. The patient underwent surgical procedure with excision of the MA, whose cultures grew methicillin-sensitive S. aureus. Our case highlights the importance of including lower limbs in 18F-FDG PET/CT acquisition in case of suspicion of septic emboli.
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Affiliation(s)
| | | | | | | | | | | | - Gérard Doll
- Cardiology, NCT+ Clinic, Saint-Cyr-Sur-Loire, France
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17
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Pugh D, Grayson P, Basu N, Dhaun N. Aortitis: recent advances, current concepts and future possibilities. Heart 2021; 107:1620-1629. [PMID: 33593995 DOI: 10.1136/heartjnl-2020-318085] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 12/24/2022] Open
Abstract
Broadly defined, aortitis refers to inflammation of the aorta and incorporates both infectious and non-infectious aetiologies. As advanced imaging modalities are increasingly incorporated into clinical practice, the phenotypic spectrum associated with aortitis has widened. The primary large vessel vasculitides, giant cell arteritis and Takayasu arteritis, are the most common causes of non-infectious aortitis. Aortitis without systemic disease or involvement of other vascular territories is classified as clinically isolated aortitis. Periaortitis, where inflammation spreads beyond the aortic wall, is an important disease subset with a distinct group of aetiologies. Infectious aortitis can involve bacterial, viral or fungal pathogens and, while uncommon, can be devastating. Importantly, optimal management strategies and patient outcomes differ between aortitis subgroups highlighting the need for a thorough diagnostic workup. Monitoring disease activity over time is also challenging as normal inflammatory markers do not exclude significant vascular inflammation, particularly after starting treatment. Additional areas of unmet clinical need include clear disease classifications and improved short-term and long-term management strategies. Some of these calls are now being answered, particularly with regard to large vessel vasculitis where our understanding has advanced significantly in recent years. Work extrapolated from temporal artery histology has paved the way for targeted biological agents and, although glucocorticoids remain central to the management of non-infectious aortitis, these may allow reduced glucocorticoid reliance. Future work should seek to clarify disease definitions, improve diagnostic pathways and ultimately allow a more stratified approach to patient management.
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Affiliation(s)
- Dan Pugh
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Peter Grayson
- National Institute of Arthritis & Musculoskeletal & Skin Diseases, NIH, Bethesda, Maryland, USA
| | - Neil Basu
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - Neeraj Dhaun
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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18
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Neurologic complications of diseases of the aorta. HANDBOOK OF CLINICAL NEUROLOGY 2021; 177:221-239. [PMID: 33632441 DOI: 10.1016/b978-0-12-819814-8.00028-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Neurologic complications of diseases of the aorta are common, as the brain and spinal cord function is highly dependent on the aorta and its branches for blood supply. Any disease impacting the aorta may have significant impact on the ability to deliver oxygenated blood to the central nervous system, resulting in ischemia-and if prolonged-cerebral and spinal infarct. The breadth of pathology affecting the aorta is diverse and neurologic complications can vary dramatically based on the location, severity, and underlying etiology. This chapter outlines the major pathology of the aorta while highlighting the associated neurologic complications. This chapter covers the entire spectrum of neurologic complications associated with aortic disease by beginning with a detailed overview of the spinal cord vascular anatomy followed by a discussion of the most common aortic pathologies affecting the nervous system, including aortic aneurysm, aortic dissection, aortic atherosclerosis, inflammatory and infectious aortopathies, congenital abnormalities, and aortic surgery.
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19
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Liou YT, Tsai CY. Abdominal mycotic aortic aneurysm presenting as chronic constipation. Am J Emerg Med 2020; 42:260.e1-260.e2. [PMID: 33388185 DOI: 10.1016/j.ajem.2020.12.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 12/16/2020] [Accepted: 12/19/2020] [Indexed: 11/26/2022] Open
Abstract
A mycotic aneurysm is a life-threatening disease that usually presents with nonspecific symptoms. A prompt diagnosis is essential because of the risk of aneurysm rupture and high mortality rate. We describe a case of an abdominal mycotic aortic aneurysm presenting as chronic constipation for 3 weeks, without fever or abdominal pain. Point-of-care ultrasound has the ability to detect silent abdominal aortic aneurysms and serves as a follow-up tool for patients under medical treatment.
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Affiliation(s)
- Yaw-Tzeng Liou
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
| | - Chun-Yi Tsai
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan.
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20
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van der Zwaan HB, Sieswerda GT, Krings GJ, Voskuil M. Infectious stentitis after treatment of coarctation of the aorta: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-5. [PMID: 32617465 PMCID: PMC7319810 DOI: 10.1093/ehjcr/ytaa081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 11/18/2019] [Accepted: 03/17/2020] [Indexed: 11/13/2022]
Abstract
Background Aortitis is a rare condition that can be caused by inflammatory or infectious aetiologies. The clinical presentation of aortitis includes a heterogeneous range of symptoms and clinical signs. Case summary We present a 53-year-old man whose medical history included presence of a ventricular septal defect, a bicuspid aortic valve, and coarctation of the aorta. The coarctation was treated with percutaneous stent implantation. One and a half years later, he presented to our hospital with complaints of fatigue, night sweats, and shivers. Physical examination revealed a fever, tachycardia, and hypertension. Imaging studies showed no signs of endocarditis. Positron emission tomography-computed tomography (PET-CT) showed an increase in 18F-fluorodeoxyglucose uptake at the distal end of the stent in the descending aorta. Blood cultures revealed a Streptococcus gordonii and antibiotic treatment was adjusted accordingly. The patients' functional status improved quickly, the fever resolved, and the laboratory markers of inflammation returned to normal. Discussion Aortitis is extremely rare after stent implantation. Risk factors for aortitis include congenital vascular malformation and stent implantation. Computed tomography is currently the imaging study of choice for aortitis, while PET-CT seems ideal for identification of stent infection. Mortality associated with infectious aortitis ranges from 21% to 44%, with generally higher mortality if managed with antibiotics alone. The differential diagnosis of stent infection should be taken into account in patients presenting with fever and chills after previous stent procedures.
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Affiliation(s)
- Heleen B van der Zwaan
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Gertjan Tj Sieswerda
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Gregor J Krings
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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21
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Sharma S, Pandey NN, Sinha M, Chandrashekhara SH. Etiology, Diagnosis and Management of Aortitis. Cardiovasc Intervent Radiol 2020; 43:1821-1836. [PMID: 32390100 DOI: 10.1007/s00270-020-02486-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/08/2020] [Indexed: 01/02/2023]
Abstract
Aortitis includes conditions with infectious or non-infectious etiology, characterized by inflammatory changes in one or more layers in aortic wall. Age at onset, geographic predilections, distribution and pattern of involvement in aorta, its branches and pulmonary arteries, and systemic associations provide a clue to etiology. Clinical presentations are often non-specific. An integrated approach including clinical, laboratory and imaging assessment is essential to confirm diagnosis and plan treatment. Assessment of disease activity is the key as it influences timing and outcome of treatment. Markers of activity include clinical, laboratory and imaging. Medical management remains the first-line therapy. Revascularization is indicated in the presence of hemodynamically significant stenosis and inactive disease. In the presence of flash pulmonary edema, left ventricular dysfunction or hypertensive encephalopathy, revascularization is performed irrespective of disease activity. Endovascular management is favored over surgery due to its high success and low restenosis rates. Symptomatic aneurysmal disease is usually managed by surgery.
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Affiliation(s)
- Sanjiv Sharma
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Niraj Nirmal Pandey
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Mumun Sinha
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - S H Chandrashekhara
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029, India
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22
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HIV-Associated Aortitis Causing Rapid Development of an Abdominal Aortic Aneurysm. Ann Vasc Surg 2020; 66:669.e11-669.e15. [PMID: 32018021 DOI: 10.1016/j.avsg.2020.01.088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 10/15/2019] [Accepted: 01/05/2020] [Indexed: 11/22/2022]
Abstract
Vasculitides are rare manifestations of human immunodeficiency virus (HIV) infection. They encompass a wide range of different pathologies, both infectious and noninfectious. We present the case of a 68-year-old female with HIV, being treated with antiretrovirals, who presented with a symptomatic abdominal aortic aneurysm. The aneurysm developed within one week. The patient underwent endovascular aneurysm repair, and her aneurysm completely resolved on follow-up computed tomography imaging 16 months later. We also present a review of HIV-associated vascular pathologies.
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23
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Rullo J, Mehraban Far P, Farmer JF, Clements-Baker M, Ten Hove M. A curious case of arteritis: infectious, inflammatory, or both. Can J Ophthalmol 2019; 54:e288-e292. [PMID: 31836116 DOI: 10.1016/j.jcjo.2019.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 02/17/2019] [Accepted: 02/18/2019] [Indexed: 11/18/2022]
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24
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Denny KJ, Kumar A, Timsit JF, Laupland KB. Extra-cardiac endovascular infections in the critically ill. Intensive Care Med 2019; 46:173-181. [PMID: 31745594 DOI: 10.1007/s00134-019-05855-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/04/2019] [Indexed: 01/16/2023]
Abstract
Vascular infections are associated with high complication rates and mortality. While there is an extensive body of literature surrounding cardiac infections including endocarditis, this is less so the case for other endovascular infections. The objective of this narrative review is to summarize the epidemiology, clinical features, and selected management of severe vascular infections exclusive of those involving the heart. Endovascular infections may involve either the arterial or venous vasculature and may arise in native vessels or secondary to implanted devices. Management is complex and requires multi-disciplinary involvement from the outset. Infective arteritis or device-related arterial infection involves removal of the infected tissue or device. In cases where complete excision is not possible, prolonged courses of antimicrobials are required. Serious infections associated with the venous system include septic thrombophlebitis of the internal jugular and other deep veins, and intracranial/venous sinuses. Source control is of paramount importance in these cases with adjunctive antimicrobial therapy. The role of anticoagulation is controversial although recommended in the absence of contraindications. An improved understanding of the management of these infections, and thus improved patient outcomes, requires multi-center, international collaboration.
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Affiliation(s)
- Kerina J Denny
- Department of Intensive Care, Gold Coast University Hospital, Gold Coast, QLD, Australia.,Burns, Trauma and Critical Care Research Centre, University of Queensland, Herston, QLD, Australia
| | - Anand Kumar
- Sections of Critical Care Medicine and Infectious Diseases, Health Sciences Centre, Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Jean-Francois Timsit
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), 75018, Paris, France.,University of Paris, IAME, INSERM, 75018, Paris, France
| | - Kevin B Laupland
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia. .,Queensland University of Technology, Brisbane, QLD, Australia.
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25
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Callemeyn J, Daenens K, Derdelinckx I, Dymarkowski S, Fagard K. Conservative treatment of non-aneurysmal infectious aortitis: a case report and review of the literature. Acta Clin Belg 2019; 74:86-91. [PMID: 29745308 DOI: 10.1080/17843286.2018.1467586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND Non-aneurysmal infectious aortitis is a rare clinical entity with most often lethal complications when surgical intervention is delayed. OBJECTIVES This report describes the case of a non-aneurysmal infectious aortitis complicated with a penetrating aortic ulcer in an elderly woman, caused by a methicillin-sensitive Staphylococcus aureus. Surgery was deemed contra-indicated and treatment was limited to the administration of intravenous vancomycin (2 grams daily), followed by flucloxacillin (6 times 2 grams daily). She remains well after one year. METHODS The Internet databases Medline and Embase were searched. Articles were selected based on relevanceof abstract, article type and impact of the journal. RESULTS A literature review addresses current insights in the pathogenesis, diagnosis, and treatment of non-aneurysmal infectious aortitis.
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Affiliation(s)
- Jasper Callemeyn
- Faculty of Medicine, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Kim Daenens
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Inge Derdelinckx
- Department of Internal Medicine, Infectious Diseases, University Hospitals Leuven, Leuven, Belgium
| | | | - Katleen Fagard
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
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Abstract
Patients with aortitis often present with nonspecific constitutional symptoms. Due to the fact that aortitis is associated with inflammatory or infectious courses, patients may manifest fever or fever of unknown origin. Such clinical characteristics of aortitis are unavoidably brought about diagnostic dilemmas and might lead to a series of unnecessary work-ups and maltreatment. Therefore, it is important for the clinical physicians and surgeons to understand aortitis presenting with fever of unknown origin to avoid delayed diagnosis and treatment. In this article, clinical and pathological features of aortitis (giant cell arteritis, Takayasu arteritis and infective aortitis, etc.) with fever of unknown origin are described and the differential diagnosis and management policy are discussed.
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Affiliation(s)
- Shi-Min Yuan
- Department of Cardiothoracic Surgery, Teaching Hospital, Fujian Medical University, Putian, Fujian, China
| | - Hong Lin
- Department of Cardiology, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian, Fujian, China
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Diagnosis and differential diagnosis of large-vessel vasculitides. Rheumatol Int 2018; 39:169-185. [PMID: 30221327 DOI: 10.1007/s00296-018-4157-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 09/10/2018] [Indexed: 12/13/2022]
Abstract
There are no universally accepted diagnostic criteria for large-vessel vasculitides (LVV), including giant cell arteritis (GCA) and Takayasu arteritis (TAK). Currently, available classification criteria cannot be used for the diagnosis of GCA and TAK. Early diagnosis of these two diseases is quite challenging in clinical practice and may be accomplished only by combining the patient symptoms, physical examination findings, blood test results, imaging findings, and biopsy results, if available. Awareness of red flags which lead the clinician to investigate TAK in a young patient with persistent systemic inflammation is helpful for the early diagnosis. It should be noted that clinical presentation may be highly variable in a subgroup of GCA patients with predominant large-vessel involvement (LVI) and without prominent cranial symptoms. Imaging modalities are especially helpful for the diagnosis of this subgroup. Differential diagnosis between older patients with TAK and this subgroup of GCA patients presenting with LVI may be difficult. Various pathologies may mimic LVV either by causing systemic inflammation and constitutional symptoms, or by causing lumen narrowing with or without aneurysm formation in the aorta and its branches. Differential diagnosis of aortitis is crucial. Infectious aortitis including mycotic aneurysms due to septicemia or endocarditis, as well as causes such as syphilis and mycobacterial infections should always be excluded. On the other hand, the presence of non-infectious aortitis is not unique for TAK and GCA. It should be noted that aortitis, other large-vessel involvement or both, may occasionally be seen in various other autoimmune pathologies including ANCA-positive vasculitides, Behçet's disease, ankylosing spondylitis, sarcoidosis, and Sjögren's syndrome. Besides, aortitis may be idiopathic and isolated. Atherosclerosis should always be considered in the differential diagnosis of LVV. Other pathologies which may mimic LVV include, but not limited to, congenital causes of aortic coarctation and middle aortic syndrome, immunoglobulin G4-related disease, and hereditary disorders of connective tissue such as Marfan syndrome and Ehler-Danlos syndrome.
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Rimac G, Lafleur A. Acute infectious aortitis presenting as pyelonephritis. Am J Emerg Med 2018; 36:1722.e5-1722.e7. [DOI: 10.1016/j.ajem.2018.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 06/06/2018] [Indexed: 10/14/2022] Open
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Sailer AM, Bakers FC, Daemen JW, Vöö S. 18F-FDG PET/MRI in the diagnosis of an infected aortic aneurysm. Cardiovasc Diagn Ther 2018; 8:S208-S211. [PMID: 29850433 DOI: 10.21037/cdt.2017.08.05] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
We report a case where an integrated whole body 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/magnetic resonance imaging (MRI) is performed in the diagnostic work-up of a saccular aortic aneurysm. The integrated whole body 18F-FDG PET/MRI study answered all relevant diagnostic questions, clearly marking an infected aortic aneurysm, depicting the extent of the infected area in relation to the aortic branch vessels, and indicating the aortic lesion as the primary site of infection. The patient was successfully treated by open type V TAAA repair and pericardial graft replacement. Aortic wall infection was proven in cultures of the surgical specimen.
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Affiliation(s)
- Anna M Sailer
- Department of Radiology, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Radiology, Stanford University School of Medicine, Stanford, USA
| | - Frans C Bakers
- Department of Radiology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Jan W Daemen
- Department of Vascular Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Stefan Vöö
- Department of Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Nuclear Medicine, University College London Hospitals, London, UK
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Infectious Aortitis: A Life-Threatening Endovascular Complication of Nontyphoidal Salmonella Bacteremia. Case Rep Med 2018; 2018:6845617. [PMID: 29808097 PMCID: PMC5902092 DOI: 10.1155/2018/6845617] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 02/18/2018] [Accepted: 02/22/2018] [Indexed: 11/17/2022] Open
Abstract
A 65-year-old Japanese man living in the United States presented with pyrexia and chills associated with intermittent lower abdominal and back pain for 5 days. He denied recent travel, rash, diarrhea, or rectal bleeding. Physical examination revealed spiking pyrexia, and routine laboratory tests revealed mild leukocytosis and neutrophilia. Abdominal CT with contrast showed findings highly compatible with aortitis. Comprehensive autoimmune evaluation was negative. Salmonella enterica serotype Enteritidis was isolated from blood cultures. IV antibiotics were administered, but the patient continued to experience low-grade pyrexia and mild leukocytosis, and follow-up abdominal CT showed progressive aortic inflammation. The patient therefore underwent resection of the affected aortic segment with in-situ graft replacement and lifelong suppressive antibiotics. The patient is asymptomatic with no complications at 18 weeks of follow-up. This case report illustrates that patients with infectious aortitis from nontyphoidal Salmonella may (1) present with nonspecific and nonlocalizing symptoms and signs except for sepsis; (2) have diagnostic blood cultures and abdominal CT findings; and (3) typically require aggressive, prolonged IV antibiotic therapy and surgery for potential cure of this life-threatening infection.
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CT analysis of the aorta in giant-cell arteritis: a case-control study. Eur Radiol 2018; 28:3676-3684. [PMID: 29600479 DOI: 10.1007/s00330-018-5311-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 12/16/2017] [Accepted: 01/03/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Giant cell arteritis (GCA) is a large-vessel vasculitis whose diagnosis is confirmed by temporal artery biopsy. However, involvement of large vessels, especially the aorta, can be shown by imaging, which plays an increasing role in GCA diagnosis. The threshold above which aortic wall thickening, as measured by computed tomography (CT), is considered pathological is controversial, with values ranging from 2 to 3 mm. This study assessed aortic morphology by CT scan and its diagnostic value in GCA. METHODS Altogether, 174 patients were included (64 with GCA, 43 with polymyalgia rheumatica and 67 controls). All patients had a CT scan at diagnosis or at inclusion for controls. Aortic wall thickness, aortic diameter and scores for atheroma were measured. Assessor was blinded to each patient's group. RESULTS Aortic diameters and atheroma scores were similar between groups. Aortic wall thickness was greater in the GCA group, even after the exclusion of GCA patients with aortic wall thickness ≥3 mm. The receiver operating characteristic (ROC) curve showed that a wall thickness of 2.2 mm was the optimal threshold to diagnose GCA (sensitivity, 67%; specificity, 98%). CONCLUSIONS Measuring aortic wall thickness by CT scan is effective to diagnose GCA. The optimal threshold to regard aortic wall thickening as pathological was ≥2.2 mm. KEY POINTS • Imaging, including CT scan, plays an increasing role in GCA diagnosis • CT measurement of aortic wall thickness is useful to diagnose GCA • A 2.2-mm threshold allows the diagnosis of thickened aortic wall in GCA.
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Snead CM, Crockett SC, Bailey PK. Non-infectious aortitis in an immunosuppressed renal transplant recipient with IgA nephropathy. BMJ Case Rep 2017; 2017:bcr-2017-221136. [PMID: 29054943 DOI: 10.1136/bcr-2017-221136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 54-year-old woman presented with atypical chest pain, fever and malaise. She was immunosuppressed with three agents following a living-donor kidney transplant 1 year previously. Her native kidney failure was secondary to biopsy-demonstrated crescentic IgA nephropathy, with systemic involvement. A CT pulmonary angiogram revealed an inflammatory cuff of soft tissue around the descending thoracic aorta suggesting aortitis. Inflammatory markers were elevated. Given her immunosuppression, the patient was screened extensively for infective causes and was empirically commenced on intravenous meropenem. After 72 hours of no clinical or serological response to antibiotic therapy, negative microbiological investigations and worsening inflammation on serial imaging, she was commenced on high-dose methylprednisolone for presumed inflammatory aortitis. Symptoms and inflammatory markers rapidly normalisedand the patient was discharged home on oral prednisolone. A clinical diagnosis of IgA-related aortitis was made. Imaging 3 months later showed complete resolution of the aortitis.
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Avenatti E, Iafrati MD, Patel V, Little SH, Pandian NG, Ianchulev SA. Acute Aortic Syndrome - More in the Spectrum. J Cardiothorac Vasc Anesth 2017; 31:1735-1739. [PMID: 28826685 DOI: 10.1053/j.jvca.2017.04.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Eleonora Avenatti
- Department of Cardiology, DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX.
| | - Mark D Iafrati
- Department of Vascular Surgery, Tufts Medical Center, Boston, MA
| | - Visal Patel
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA
| | - Stephen H Little
- Department of Cardiology, DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX
| | - Natesa G Pandian
- Department of Cardiovascular Imaging and Hemodynamic Laboratory, Tufts Medical Center, Boston, MA
| | - Stefan A Ianchulev
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA
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Infrarenal Infected Aortic Aneurysm Caused by Streptococcus pyogenes. Case Rep Surg 2017; 2017:9329504. [PMID: 28503338 PMCID: PMC5414497 DOI: 10.1155/2017/9329504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 02/28/2017] [Indexed: 11/21/2022] Open
Abstract
Infectious aneurysm is a rare entity associated with significant morbidity and mortality. Current knowledge on pathogenesis, outcome, diagnosis, management, and follow-up remains debatable. We report the case of a patient with Streptococcus pyogenes aneurysm who was successfully treated with a homograft implant and discuss microbiological characteristics, diagnostic methods, and treatment options currently available for this serious disease.
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35
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Prevotella intermedia infection causing acute and complicated aortitis-A case report. Int J Surg Case Rep 2017; 32:58-61. [PMID: 28249232 PMCID: PMC5328935 DOI: 10.1016/j.ijscr.2017.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 02/11/2017] [Accepted: 02/11/2017] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Aortitis is a general term that refers to all conditions involving an inflammation of the aortic wall. This case report describes the surgical approach of a patient with infectious and symptomatic aortitis caused by the rare vector Prevotella intermedia. PRESENTATION OF CASE A 44-year old male patient was admitted with fever and general discomfort after a period of sore throat in a non-teaching hospital. After two weeks he developed acute abdominal and back pain accompanied by sweating and elevated infection parameters. Computed tomography angiography revealed atherosclerotic changes of the infrarenal aorta with a locally contained rupture of the aorta alongside peri-aortal signs of inflammation (and aortitis aspects). An urgent aortic reconstruction was performed according to Nevelsteen. The blood cultures turned out positive for Prevotella intermedia. Postoperatively the patient received antibiotics for six weeks. The patient recovered uneventful from this infection and surgical procedure. DISCUSSION A complicated and acute aortitis is a rare but potentially life-threatening disease. The aetiology can be ordered into two main groups; inflammatory and infectious. Diagnosis is based upon symptoms, biochemical values, microbiological results and imaging modalities. Treatment depends on aetiology and should be discussed in an experienced multidisciplinary setting. Infectious aortitis should be treated with antibiotics for at least six weeks with close monitoring of the patient's clinic and biochemical values, even after surgery. CONCLUSION Prevotella intermedia is a rare causative agent for aortitis. Acute aortitis is a challenging clinical entity which should be managed in an equipped medical center by an experienced multidisciplinary team.
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A Rare Cause of Primary Aortoenteric Fistula: Streptococcus parasanguinis Aortitis. Case Rep Gastrointest Med 2017; 2017:9087308. [PMID: 28255476 PMCID: PMC5306989 DOI: 10.1155/2017/9087308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/10/2017] [Accepted: 01/16/2017] [Indexed: 11/17/2022] Open
Abstract
Primary aortoenteric fistula is a rare cause of upper gastrointestinal bleed but can lead to significant mortality if the diagnosis is delayed. Aortitis, characterized by inflammation of the aortic wall, is a rare cause of aortoenteric fistula. We present a case report of a 72-year-old male patient with infectious aortoenteric fistula secondary to Streptococcus parasanguinis, along with a review of the literature. This case demonstrates the importance of early diagnosis and aggressive surgical treatment of aortoenteric fistulae and recognizing infectious aortitis as a potential etiology.
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37
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Agrawal A, Sikachi RR. Infective abdominal aortitis due to Campylobacter fetus bacteremia: A case report and review of literature. Intractable Rare Dis Res 2016; 5:290-293. [PMID: 27904826 PMCID: PMC5116866 DOI: 10.5582/irdr.2016.01059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Infectious aortitis (IA) is a rare but life-threatening condition, and most commonly affects the abdominal aorta or thoracic aorta. Various microorganisms have been associated with infectious thoracic aortitis, most commonly Staphylococcus, Enterococcus, Streptococcus, and Salmonella species. Campylobacter fetus (C. fetus) has been seen as a cause of infective aortitis only in a few case reports. We report a rare case of infective aortitis of the abdominal aorta caused due to C. fetus bacteremia. While C. fetus infections usually occur in patients with immunosuppression, such as malignancy, or those with diabetes mellitus, but our patient was not immunocompromised. Furthermore, the IA occurred in the absence of an aortic aneurysm, unlike its usual presentation. Thus, it is extremely important to establish an early diagnosis of IA and find out the causative organism for appropriate medical treatment, because this condition is potentially life threatening.
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Affiliation(s)
- Abhinav Agrawal
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, Northwell Health — Hofstra Northwell School of Medicine, New York, USA
- Address correspondence to: Dr. Abhinav Agrawal, Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, Northwell Health — Hofstra Northwell School of Medicine, New York, USA. E-mail:
| | - Rutuja R Sikachi
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, Northwell Health — Hofstra Northwell School of Medicine, New York, USA
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38
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Murphy DJ, Keraliya AR, Agrawal MD, Aghayev A, Steigner ML. Cross-sectional imaging of aortic infections. Insights Imaging 2016; 7:801-818. [PMID: 27761883 PMCID: PMC5110479 DOI: 10.1007/s13244-016-0522-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/15/2016] [Accepted: 09/28/2016] [Indexed: 12/25/2022] Open
Abstract
Aortic infections are uncommon clinical entities, but are associated with high rates of morbidity and mortality. In this review, we focus on the cross-sectional imaging appearance of aortic infections, including aortic valve endocarditis, pyogenic aortitis, mycotic aneurysm and aortic graft infections, with an emphasis on CT, MRI and PET/CT appearance. Teaching Points • Aortic infections are associated with high morbidity and mortality. • CT, MRI and FDG PET/CT play complementary roles in aortic infection imaging. • Radiologists should be vigilant for aortic infection manifestations to ensure timely diagnosis.
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Affiliation(s)
- D J Murphy
- Division of Non-invasive Cardiovascular Imaging, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
| | - A R Keraliya
- Division of Non-invasive Cardiovascular Imaging, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - M D Agrawal
- Division of Non-invasive Cardiovascular Imaging, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - A Aghayev
- Division of Non-invasive Cardiovascular Imaging, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - M L Steigner
- Division of Non-invasive Cardiovascular Imaging, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
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Cho DD, Berliner Y, Carr D. Deadly case of Pasteurella multocida aortitis and mycotic aneurysm following a cat bite. World J Clin Cases 2016; 4:142-145. [PMID: 27326399 PMCID: PMC4909459 DOI: 10.12998/wjcc.v4.i6.142] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 04/03/2016] [Accepted: 04/22/2016] [Indexed: 02/05/2023] Open
Abstract
Animal bites are frequently encountered in the emergency department (ED). Aortitis leading to mycotic abdominal aortic aneurysm is a rare and potentially deadly complication of Pasteurella multocida (P. multocida) following an animal bite. We present the case of a 68-year-old male who presented to the ED after falling at home. He complained of weakness and abdominal pain. He was in septic shock and was treated empirically with broad-spectrum antibiotics and intravenous fluids. He reported previous antibiotic treatment of a cellulitis secondary to a cat bite injury to his right thumb four weeks prior. Abdominal ultrasound and subsequent computed tomography scan revealed a leaking mycotic abdominal aneurysm that was surgically repaired. Blood cultures and aortic wall tissue cultures grew P. multocida. Given how common animal bite presentations are in the ED, this case highlights the need to consider aortitis and mycotic abdominal aortic aneurysm in an unwell patient with an animal bite.
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40
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Töpel I, Zorger N, Steinbauer M. Inflammatory diseases of the aorta: Part 2: Infectious aortitis. GEFASSCHIRURGIE 2016; 21:87-93. [PMID: 27546993 PMCID: PMC4974295 DOI: 10.1007/s00772-016-0142-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Infectious aortitis is a rare but life-threatening disease. Due to impending local and systemic complications, prompt diagnosis and initiation of effective causal treatment are essential for patient survival. Differentiating infectious aortitis from other aortic diseases, in particular non-infectious aortitis, is of great importance. This article discusses the various causes, diagnostic tools, and therapeutic strategies for infectious aortitis.
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Affiliation(s)
- I. Töpel
- Klinik für Gefäßchirurgie, KH Barmherzige Brüder Regensburg, Prüfeninger Str. 86, 93049 Regensburg, Deutschland
| | - N. Zorger
- Institut für Radiologie, Neuroradiologie und Nuklearmedizin, Krankenhaus Barmherzige Brüder, Regensburg, Deutschland
| | - M. Steinbauer
- Klinik für Gefäßchirurgie, KH Barmherzige Brüder Regensburg, Prüfeninger Str. 86, 93049 Regensburg, Deutschland
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41
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Mycotic aneurysm of the superior and inferior mesenteric artery. J Vasc Surg 2016; 63:1638-46. [PMID: 26951998 DOI: 10.1016/j.jvs.2016.01.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 01/03/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Visceral artery aneurysms as a result of arterial degenerative disease are rare (0.1%-2%), and the superior mesenteric artery (SMA) accounts for 3.2% of all reported series. The current incidence of inferior mesenteric artery (IMA) aneurysm is unknown. However, infective causes (mycotic) of SMA and IMA aneurysm as a result of primary, secondary, and cryptogenic etiology remain a separate entity and attain fewer cases in the literature. Currently, there is no consensus on their presentation, diagnosis, and overall management. METHODS A systematic review and meta-aggregation of literature from 1944 to March 2015 in the English language and of adult subjects in MEDLINE, Ovid, CINAHL, and the Cochrane database was conducted. RESULTS The median age of patients with SMA aneurysm was 36 (range, 14-92) years, with a significant male predominance (73% vs 27%). In order of prevalence, abdominal pain (n = 25; 65%), low-grade fever (n = 23; 60%), malaise (n = 10; 26%), weight loss (n = 9; 23%), and nausea and vomiting (n = 8; 20%) were the most common presenting signs and symptoms. The most common microorganism was Streptococcus (n = 18; 47%), followed by Staphylococcus (n = 11; 28%). The investigative modality of choice was computed tomography (n = 22; 57.8%), followed by ultrasonography of the abdomen (n = 9; 23%). Primary etiology was noted in 5.4%, secondary in 71%, and cryptogenic in 13% of all cases. Aneurysmectomy alone was associated with bowel resection in four cases (10.5%), whereas aneurysmectomy with interposition vein grafting required no further intervention. The inpatient mortality after surgery was 7.8%, and the overall mortality was 15%. The median follow-up was 12 months (range, 2-120 months). The median age of patients with IMA aneurysm was 48 (range, 22-64) years, with a male predominance of 2:1 and abdominal pain in all cases (n = 3; 100%). The most common microorganism was Streptococcus (n = 2; 66.6%), and the operation of choice was aneurysmectomy (n = 2; 66.6%) after computed tomography scan (n = 3; 100%) as an investigative modality of choice. CONCLUSIONS The pentad of abdominal pain, pyrexia of unknown origin, malaise, weight loss, and nausea remains the most convincing presentation of mycotic aneurysms of the SMA and IMA. Computed tomography is the investigative modality of choice, and such patients are best served with aneurysmectomy alone in IMA aneurysms and interposition vein grafting in SMA aneurysms after initiation of antimicrobial therapy on suspicion of the diagnosis.
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Affiliation(s)
- F. Daniel Ramirez
- Division of Cardiology, University of Ottawa Heart Institute
- Cardiovascular Percutaneous Trial (CAPITAL) Research Group
| | - Bruce M. Jamison
- Department of Pathology and Laboratory Medicine, University of Ottawa
| | - Benjamin Hibbert
- Division of Cardiology, University of Ottawa Heart Institute
- Cardiovascular Percutaneous Trial (CAPITAL) Research Group
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Bossone E, Pluchinotta FR, Andreas M, Blanc P, Citro R, Limongelli G, Della Corte A, Parikh A, Frigiola A, Lerakis S, Ehrlich M, Aboyans V. Aortitis. Vascul Pharmacol 2015; 80:1-10. [PMID: 26721213 DOI: 10.1016/j.vph.2015.11.084] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 11/22/2015] [Accepted: 11/23/2015] [Indexed: 01/13/2023]
Abstract
Aortitis encompasses all conditions, infectious or non-infectious, leading to different types of inflammation of the aortic wall. The clinical manifestations are usually nonspecific, as are laboratory findings, and sometimes may mimic other diseases. Imaging modalities can help in the assessment of these patients and are often required for making the final diagnosis. It is extremely important to establish an early diagnosis in order to treat timely potentially life-threatening conditions. Anti-inflammatory drugs, antibiotics, sometimes in combination with surgical or endovascular therapies, are proposed according to etiology and disease severity. This review focuses on the classification, epidemiology, diagnostic approach, and management of aortitis with which physicians should be familiar.
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Affiliation(s)
| | - Francesca R Pluchinotta
- Department of Pediatric Cardiology and Adult with Congenital Heart Disease, IRCCS Policlinico San Donato, Milan, Italy
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Philippe Blanc
- Department of Nuclear Medicine, Dupuytren University Hospital, Limoges, France
| | - Rodolfo Citro
- Heart Department, University Hospital, Salerno, Italy
| | - Giuseppe Limongelli
- Division of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy
| | - Alessandro Della Corte
- Department of Cardiothoracic Sciences, Monaldi Hospital, Second University of Naples, Naples, Italy
| | - Ankit Parikh
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Alessandro Frigiola
- Department of Pediatric Cardiology and Adult with Congenital Heart Disease, IRCCS Policlinico San Donato, Milan, Italy
| | - Stamatios Lerakis
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Marek Ehrlich
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital, Limoges, France; Inserm 1094, Limoges School of Medicine, Limoges, France
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Pathirana U, Kularatne S, Karunaratne S, Ranasinghe G, Fernando J. Ascending aortic aneurysm caused by Mycobacterium tuberculosis. BMC Res Notes 2015; 8:659. [PMID: 26553119 PMCID: PMC4638108 DOI: 10.1186/s13104-015-1667-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 11/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tuberculous aortitis is an unusual presentation of a common disease in Sri Lanka. There were no reported cases of tuberculous aortitis from Sri Lanka. Here we report a case of a 40-year-old woman who developed an ascending aortic aneurysm with severe aortic regurgitation caused by Mycobacterium tuberculosis. CASE PRESENTATION A 40-year-old Sri Lankan female who presented with exertional breathlessness (NYHA II) and weight loss for 4 weeks duration was found to have collapsing pulse and early diastolic murmur at left sternal edge. Transthoracic and transesophageal echocardiogram showed ascending aortic aneurysm with severe aortic regurgitation. Computed tomographic aortography confirmed the diagnosis of aneurysmal dilatation of the ascending aorta. She underwent successful aortic valve replacement and aortic root replacement. The final diagnosis of tuberculous aortitis was made on the basis of macroscopic appearance of inflammation and microscopic confirmation of caseating granuloma. She made a good clinical recovery with category 1 antituberculous chemotherapy. CONCLUSIONS Although most cases of aortitis are non-infectious in Sri Lanka, an infectious etiology must be considered in the differential diagnosis because therapeutic approaches differ widely. Tuberculous aortitis may be under diagnosed in Sri Lanka, a country with intermediate tuberculosis burden, as the histological or microbiological diagnosis is not possible in most cases. The clinical and radiological diagnostic criteria for tuberculous aortitis need to be set out in case of aneurysmal aortic disease in the absence of apparent etiology.
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Affiliation(s)
- Upul Pathirana
- Department of Respiratory Medicine, National Hospital for Respiratory Diseases, Welisara, Sri Lanka.
| | - Saman Kularatne
- Department of Respiratory Medicine, National Hospital for Respiratory Diseases, Welisara, Sri Lanka.
| | - Suneth Karunaratne
- Department of Cardiology, National Hospital of Sri Lanka, Colombo, Sri Lanka.
| | - Gamini Ranasinghe
- Department of Cardiothoracic Surgery, National Hospital of Sri Lanka, Colombo, Sri Lanka.
| | - Janakie Fernando
- Department of Pathology, National Hospital of Sri Lanka, Colombo, Sri Lanka.
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Abe S, Okada Y, Sato T, Suzuki K. Multiple infectious pseudoaneurysms: An autopsy case. Leg Med (Tokyo) 2015; 17:517-20. [DOI: 10.1016/j.legalmed.2015.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 10/28/2015] [Accepted: 10/28/2015] [Indexed: 11/28/2022]
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Bartonella quintana Aortitis in a Man with AIDS, Diagnosed by Needle Biopsy and 16S rRNA Gene Amplification. J Clin Microbiol 2015; 53:2773-6. [PMID: 26063867 DOI: 10.1128/jcm.02888-14] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 05/28/2015] [Indexed: 11/20/2022] Open
Abstract
A man with newly diagnosed AIDS presented with months of back pain and fever. Computed tomography (CT) results demonstrated aortitis with periaortic tissue thickening. DNA amplification of biopsy tissue revealed Bartonella quintana, and Bartonella serologies were subsequently noted to be positive. The patient improved with prolonged doxycycline and rifabutin treatment. This case illustrates how molecular techniques are increasingly important in diagnosing Bartonella infections.
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Maleszewski JJ. Inflammatory ascending aortic disease: Perspectives from pathology. J Thorac Cardiovasc Surg 2015; 149:S176-83. [DOI: 10.1016/j.jtcvs.2014.07.046] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 07/24/2014] [Indexed: 12/11/2022]
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48
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Large Vessel Vasculitis Occurring in Rheumatoid Arthritis Patient under Anti-TNF Therapy. Case Rep Med 2014; 2014:624184. [PMID: 25544845 PMCID: PMC4269210 DOI: 10.1155/2014/624184] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 11/19/2014] [Indexed: 11/17/2022] Open
Abstract
Vasculitis is a heterogeneous group of disorders characterized by the presence of necrotic inflammatory phenomena and destruction of blood vessels. Vasculitis is classified as primary (idiopathic) or secondary to infections, connective tissue diseases and drugs but can also be considered as a paraneoplastic phenomenon. Evidence shows that the increasing use of biological agents results in a growing number of reports of autoimmune diseases induced by these therapies. An inflammatory articular chronic disease such as rheumatoid arthritis may be complicated by extra-articular manifestations, such as cutaneous or systemic vasculitis. Herewith, we describe the case of a great vessels arteritis in a patient affected by rheumatoid arthritis in therapy with an anti-TNF agent (etanercept).
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Bhalla S, Menias CO. Case of the season: infectious pseudoaneurysm presenting with acute mediastinal widening. Semin Roentgenol 2014; 49:130-3. [PMID: 24836488 DOI: 10.1053/j.ro.2014.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sanjeev Bhalla
- Washington University of St. Louis, Mallinckrodt Institute of Radiology, St. Louis, MO.
| | - Christine O Menias
- Washington University of St. Louis, Mallinckrodt Institute of Radiology, St. Louis, MO
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50
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Patrício C, da Silva FP, Brotas V. Pulmonary oedema in the emergency room: what is hidden beyond an apparently common presentation. BMJ Case Rep 2014; 2014:bcr-2014-204131. [PMID: 24792026 DOI: 10.1136/bcr-2014-204131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cardiogenic flash pulmonary oedema is a common and potentially fatal cause of acute respiratory distress. Although it often results from acute decompensated heart failure, abrupt-onset aortic regurgitation can sharply rise cardiac filling pressure and, consequently, pulmonary venous pressure, leading to rapid fluid accumulation in the interstitial and alveolar spaces. We report a case of a 64-year-old woman admitted to the emergency department with a flash pulmonary oedema; a careful clinical investigation subsequently revealed a rare aetiology for this 'common' presentation. After a detailed auscultation that unmasked a diastolic cardiac murmur, an acute severe aortic insufficiency was further confirmed by echocardiography, showing inflammation and thickening of the entire aorta wall. The patient was submitted to valve replacement surgery, and histological examination, to our surprise, showed features of aortitis, remarkable for the presence of giant cells. A diagnosis of idiopathic aortitis versus inaugural giant cell arteritis was proposed and treatment started with corticosteroids.
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Affiliation(s)
- Catarina Patrício
- Department of Internal Medicine-3, Hospital de Santo António dos Capuchos, Lisboa, Portugal
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