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Sanei Taheri M, Nekooghadam SM, Tabatabaei ZS, Rezaei S. Infected Ruptured Pseudo-aneurysm in Descending Aorta; a Case Report. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2024; 12:e23. [PMID: 38572220 PMCID: PMC10988175 DOI: 10.22037/aaem.v12i1.2203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
Aortitis is the inflammation of the aortic wall. It can be caused by both infectious and non-infectious etiologies. Mycotic aneurysm is a rare, serious medical condition and typically requires prompt treatment with antibiotics, surgical intervention, or endovascular procedures to prevent rupture and complications. Here we reported, a 66-year-old male patient with a medical history of diabetes and hypertension, who presented to the emergency department (ED) with left-sided hemiplegia. Brain magnetic resonance imaging (MRI) revealed infarction in the right parietooccipital and left occipital lobes, demonstrating an embolic pattern. laboratory analysis revealed elevated levels of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and white blood cell (WBC). In order to investigate the possibility of sepsis, a non-contrast chest computed tomography (CT) scan was performed, which showed a soft tissue density surrounded by gas in the posterior mediastinum; for which the rupture of esophagus and infected aorta pseudoaneurysm were among differential diagnoses. To confirm the diagnosis, CT angiography was ordered. The infected ruptured pseudo-aneurysm(s) was confirmed and patient underwent thoracotomy surgery.
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Affiliation(s)
- Morteza Sanei Taheri
- Department of Radiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Shohada-e-Tajrish Hospital, Tehran, Iran
| | - Sayyed Mojtaba Nekooghadam
- Department of Internal Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Shohada-e-Tajrish Hospital, Tehran, Iran
| | - Zahra Sadat Tabatabaei
- Department of Radiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Shohada-e-Tajrish Hospital, Tehran, Iran
| | - Sahar Rezaei
- Department of Radiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Shohada-e-Tajrish Hospital, Tehran, Iran
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2
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Kim SE, Yoon JC, Lee JB, Jeong T, Jin Y. Emphysematous Salmonella-Infected Aneurysm of the Aortic Arch: Case Report. J Emerg Med 2023; 64:70-73. [PMID: 36464549 DOI: 10.1016/j.jemermed.2022.08.006] [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: 03/28/2022] [Revised: 05/20/2022] [Accepted: 08/04/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Infected aortic aneurysm is a relatively rare disease with significant morbidity and mortality. Because of its deeper position, patients with infected aortic arch aneurysms may present with only fever and other vague symptoms, such as weakness, fatigue, dizziness, anorexia, and functional decline. It is difficult confirm a diagnosis that is based solely on history or physical examination, and it may only be apparent on imaging studies. CASE REPORT We present a brief case report of a patient presenting to the emergency department with unexplained fever who was diagnosed with emphysematous salmonella-infected aneurysm of the aortic arch. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Infected aortic arch aneurysm is an extremely unusual disease entity that emergency physicians encounter. Because of the high mortality and morbidity of this catastrophic disease, an infected aortic aneurysm should be considered as a possible diagnosis in patients with persistent fever and vague symptoms without a specific infection focus. To avoid delayed diagnosis, emergency physicians should be aware of infected aortic arch aneurysm.
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Affiliation(s)
- So Eun Kim
- Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju-si, Republic of Korea; Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju-si, Republic of Korea; Department of Emergency Medicine, Jeonbuk National University Medical School, Jeonju, Korea
| | - Jae Chol Yoon
- Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju-si, Republic of Korea; Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju-si, Republic of Korea; Department of Emergency Medicine, Jeonbuk National University Medical School, Jeonju, Korea
| | - Jae Baek Lee
- Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju-si, Republic of Korea; Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju-si, Republic of Korea; Department of Emergency Medicine, Jeonbuk National University Medical School, Jeonju, Korea
| | - Taeoh Jeong
- Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju-si, Republic of Korea; Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju-si, Republic of Korea; Department of Emergency Medicine, Jeonbuk National University Medical School, Jeonju, Korea
| | - Youngho Jin
- Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju-si, Republic of Korea; Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju-si, Republic of Korea; Department of Emergency Medicine, Jeonbuk National University Medical School, Jeonju, Korea
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3
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Amouei M, Momtazmanesh S, Kavosi H, Davarpanah AH, Shirkhoda A, Radmard AR. Imaging of intestinal vasculitis focusing on MR and CT enterography: a two-way street between radiologic findings and clinical data. Insights Imaging 2022; 13:143. [PMID: 36057741 PMCID: PMC9440973 DOI: 10.1186/s13244-022-01284-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/04/2022] [Indexed: 11/21/2022] Open
Abstract
Diagnosis of intestinal vasculitis is often challenging due to the non-specific clinical and imaging findings. Vasculitides with gastrointestinal (GI) manifestations are rare, but their diagnosis holds immense significance as late or missed recognition can result in high mortality rates. Given the resemblance of radiologic findings with some other entities, GI vasculitis is often overlooked on small bowel studies done using computed tomography/magnetic resonance enterography (CTE/MRE). Hereon, we reviewed radiologic findings of vasculitis with gastrointestinal involvement on CTE and MRE. The variety of findings on MRE/CTE depend upon the size of the involved vessels. Signs of intestinal ischemia, e.g., mural thickening, submucosal edema, mural hyperenhancement, and restricted diffusion on diffusion-weighted imaging, are common in intestinal vasculitis. Involvement of the abdominal aorta and the major visceral arteries is presented as concentric mural thickening, transmural calcification, luminal stenosis, occlusion, aneurysmal changes, and collateral vessels. Such findings can be observed particularly in large- and medium-vessel vasculitis. The presence of extra-intestinal findings, including within the liver, kidneys, or spleen in the form of focal areas of infarction or heterogeneous enhancement due to microvascular involvement, can be another radiologic clue in diagnosis of vasculitis. The link between the clinical/laboratory findings and MRE/CTE abnormalities needs to be corresponded when it comes to the diagnosis of intestinal vasculitis.
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Affiliation(s)
- Mehrnam Amouei
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, North Kargar St., Tehran, 14117, Iran
| | - Sara Momtazmanesh
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, North Kargar St., Tehran, 14117, Iran
| | - Hoda Kavosi
- Department of Rheumatology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir H Davarpanah
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, USA
| | - Ali Shirkhoda
- Department of Radiological Science, University of California at Irvine, Irvine, USA
| | - Amir Reza Radmard
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, North Kargar St., Tehran, 14117, Iran.
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4
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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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Altuwaijri M, Altoijry A. Clinical Features of Aortitis with Gastrointestinal Involvement. Rev Cardiovasc Med 2022; 23:162. [PMID: 39077599 PMCID: PMC11273970 DOI: 10.31083/j.rcm2305162] [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: 01/04/2022] [Revised: 03/03/2022] [Accepted: 03/25/2022] [Indexed: 07/31/2024] Open
Abstract
Few vascultides have a predilection for the aorta. Among those are Takayasu arteritis, Behcet's disease, giant cell arteritis, and infectious aortitis. Diagnosis of aortitis requires a high index of suspicion since clinical features are atypical and nonspecific. However, many patients present with gastrointestinal manifestations owing to mesenteric involvement, intestinal infarction, and hepatitis. The most common vascultides that involve the aorta are Takayasu arteritis, Behcet's disease, giant cell arteritis, and infectious arteritis. Herewith, we review the literature on epidemiology, gastrointestinal manifestations, and management of each form of aortitis that affects the gastrointestinal tract.
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Affiliation(s)
- Mansour Altuwaijri
- Division of Gastroenterology, Department of Medicine, College of Medicine, King Khalid University Hospital, King Saud University, 11451 Riyadh, Saudi Arabia
| | - Abdulmajeed Altoijry
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, 11472 Riyadh, Saudi Arabia
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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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Sharma A, Ojha V, Pandey NN, Sinha M, Malhi AS, Chandrashekhara SH, Kumar S, Sharma G. Stenotic lesions of aorta: Imaging evaluation using multidetector computed tomography angiography. Asian Cardiovasc Thorac Ann 2021; 29:884-892. [PMID: 34102896 DOI: 10.1177/02184923211024094] [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: 11/15/2022]
Abstract
Aortic involvement can be secondary to various pathologic disease processes. These may result in stenotic or aneurysmal aortic lesions with a varied spectrum of imaging findings including intra-luminal, mural, and periaortic changes along with associated loco-regional or distal changes, depending on the etiology. Multidetector computer tomography with its recent advances has become the frontline imaging modality for the evaluation of aortic pathologies. Comprehensive evaluation of the aortic pathology with simultaneous evaluation of lungs, bones, and visceral organs is possible with a single multidetector computer tomography acquisition. It allows accurate primary diagnosis, identifies important anatomic landmarks and relationships, and identifies associated cardiovascular anomalies. Moreover, it serves as an adjunct in diagnosis of various complications, helps in treatment planning and detection of disease progression during follow-up.
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Affiliation(s)
- Arun Sharma
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Vineeta Ojha
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Niraj N Pandey
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Mumun Sinha
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Amarinder S Malhi
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - S H Chandrashekhara
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Gautam Sharma
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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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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9
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Abstract
Isolated noninfectious ascending aortitis (I-NIAA) is increasingly diagnosed at histopathologic review after resection of an ascending aortic aneurysm. PubMed was searched using the term aortitis; publications addressing the issue were reviewed, and reference lists of selected articles were also reviewed. Eleven major studies investigated the causes of an ascending aortic aneurysm or dissection requiring surgical repair: the prevalence of noninfectious aortitis ranged from 2% to 12%. Among 4 studies of lesions limited to the ascending aorta, 47% to 81% of cases with noninfectious aortitis were I-NIAA, more frequent than Takayasu arteritis or giant cell arteritis. Because of its subclinical nature and the lack of "syndromal signs" as in Takayasu arteritis or giant cell arteritis, I-NIAA is difficult to diagnose before complications occur, such as an aortic aneurysm or dissection. Therefore, surgical specimens of dissected aortic tissue should always be submitted for pathologic review. Diagnostic certainty requires the combination of a standardized histopathologic and clinical investigation. This review summarizes the current knowledge on I-NIAA, followed by a suggested approach to diagnosis, management, and follow-up. An illustrative case of an uncommon presentation is also presented. More follow-up studies on I-NIAA are needed, and diagnosis and follow-up of I-NIAA may benefit from the development of diagnostic biomarkers.
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Padoan R, Crimì F, Felicetti M, Padovano F, Lacognata C, Stramare R, Quaia E, Cecchin D, Bui F, Zucchetta P, Schiavon F. Fully integrated 18F-FDG PET/MR in large vessel vasculitis. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2019; 66:272-279. [PMID: 31602964 DOI: 10.23736/s1824-4785.19.03184-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND To evaluate the usefulness of [18F] fluorodeoxyglucose (FDG) positron emission tomography (PET)/magnetic resonance (MR) in large vessels vasculitis (LVV) patients. METHODS We performed an observational retrospective study based on our records. Images were acquired on a PET/MR scanner using 18F-FDG-PET whole body imaging. For each PET scan, a qualitative analysis and a semi-quantitative measure using the maximum of the standardized uptake value (SUVMax) were performed. SUVMax measurements normalized to the liver uptake were categorized using a grading scale. Vessel's wall thickness (WT) was measured at five fixed points (inferior margin of T5, T9, T12, L3, thickest area-max WT). RESULTS 23 LVV patients were included, 56.5% giant cells arteritis, 34.8% Takayasu's arteritis and 8.7% isolated aortitis, all Caucasian, mostly females (82%). We considered 32 PET scans for the LVV group (from min. 1 to max. 3 scans/patient) mainly during follow-up (29/32 scans), and 23 PET scans from a control group of non-metastatic malignancies patients. We found higher SUVMax compared to controls, in all sites, irrespective of clinical disease activity. Mean WT resulted higher in patients than in controls but was not correlated to SUVMax. Mean WT positively correlated with age in both cohorts, inversely correlated to disease duration, while no correlation with SUVMax was observed. The concordance between clinically active disease and PET hypermetabolism was poor (K Cohen 0.33). CONCLUSIONS PET/MR is a safe imaging technique capable of detecting inflammation in aortic wall. Low radiological exposure of PET/MR should be considered especially in young women receiving follow-up studies.
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Affiliation(s)
- Roberto Padoan
- Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy -
| | - Filippo Crimì
- Radiology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - Mara Felicetti
- Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - Federica Padovano
- Nuclear Medicine Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - Carmelo Lacognata
- Radiology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - Roberto Stramare
- Radiology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - Emilio Quaia
- Radiology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - Diego Cecchin
- Nuclear Medicine Unit, Department of Medicine DIMED, University of Padua, Padua, Italy.,Padova Neuroscience Center, University of Padua, Padua, Italy
| | - Franco Bui
- Nuclear Medicine Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - Pietro Zucchetta
- Nuclear Medicine Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - Franco Schiavon
- Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
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Abstract
Diagnosis of the inflammatory aortopathies and importantly, their distinction in the later stages of disease from genetically mediated or acquired (degenerative) aortopathy remains a challenging clinical problem. Historically, the diagnosis of inflammatory aortopathy has required tissue sampling and pathological assessment. Although histological diagnosis remains an important diagnostic criterion, the ability to obtain sufficient tissue samples is problematic and requires invasive approaches that pose important risk. Continuing refinement in the capabilities of multimodality imaging, including ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography provides important insights into the broad spectrum of disease which comprise the inflammatory aortopathies. This review examines the current and emerging role of multimodality imaging in the evaluation of aortitis.
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Affiliation(s)
- John P Bois
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Vidhu Anand
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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12
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Selvaraj A, Francis N, Harky A, Goli G, Bashir M. Imaging modalities in the management of aortitis. Indian J Thorac Cardiovasc Surg 2018; 35:67-71. [PMID: 33061068 DOI: 10.1007/s12055-018-0710-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/28/2018] [Accepted: 07/13/2018] [Indexed: 12/19/2022] Open
Abstract
Aortitis is a pathological term that refers to the inflammation of one or more layers of the aortic wall. It is associated with a wide spectrum of inflammatory diseases of infectious and non-infectious origins, and often present with vague clinical findings and non-specific laboratory results that can model other entities. As a result, aortitis may not form part of the initial workup and appropriate treatment can be delayed or missed. Therefore, imaging modalities are required to assess for inflammation and structural changes in the aorta to support or exclude the diagnosis of aortitis. This review presents current literature on the imaging modalities utilized in the diagnosis and management of aortitis, which surgeons and physicians should be familiar with for providing optimal patient care.
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Affiliation(s)
- Andrew Selvaraj
- Department of Cardiac Surgery, Barts Heart Centre, St. Bartholomew's Hospital, London, EC1A 7BE UK
| | - Niroshan Francis
- Department of Cardiac Surgery, Barts Heart Centre, St. Bartholomew's Hospital, London, EC1A 7BE UK
| | - Amer Harky
- Department of Vascular Surgery, Countess of Chester Hospital, Chester, CH2 1UL UK
| | - Giridhara Goli
- Department of Cardiac Surgery, Barts Heart Centre, St. Bartholomew's Hospital, London, EC1A 7BE UK
| | - Mohamad Bashir
- Department of Aortovascular Surgery, Manchester Royal Infirmary, Manchester, M13 9WL UK
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Bhave NM, Nienaber CA, Clough RE, Eagle KA. Multimodality Imaging of Thoracic Aortic Diseases in Adults. JACC Cardiovasc Imaging 2018; 11:902-919. [DOI: 10.1016/j.jcmg.2018.03.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 03/16/2018] [Accepted: 03/20/2018] [Indexed: 12/28/2022]
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Rafailidis V, Partovi S, Dikkes A, Nakamoto DA, Azar N, Staub D. Evolving clinical applications of contrast-enhanced ultrasound (CEUS) in the abdominal aorta. Cardiovasc Diagn Ther 2018; 8:S118-S130. [PMID: 29850424 DOI: 10.21037/cdt.2017.09.09] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Ultrasound (US) represents the initial modality in the workup of abdominal aortic pathology based on the plethora of advantages including widespread availability, low cost, safety profile and repeatability. However, US has inherent limitations including limited spatial information of pathologic processes to neighboring structures, lower sensitivity to slow blood flow and aortic luminal irregularities. For evaluation of aortic pathology angiography has long been considered the gold standard. Non-invasive cross-sectional imaging techniques like computed tomography angiography (CTA) and magnetic resonance angiography (MRA) have gradually replaced interventional angiography for the evaluation of aorta, currently being regarded as the diagnostic imaging modalities of choice for diagnosis of virtually every aortic disease. Interventional angiography is currently primarily performed for treatment purposes of aortic pathology. The introduction of microbubbles as ultrasonographic contrast agents has rendered contrast-enhanced ultrasound (CEUS) an evolving valuable complementary technique with markedly increased diagnostic accuracy for certain aortic applications. CEUS is characterized by the potential to be performed in patients with impaired renal function. Due to its superior spatial and temporal resolution, ability for prolonged scanning and dynamic and real-time imaging, it provides clinically significant additional information compared to the standard Duplex US. The purpose of this paper is to discuss the currently available literature regarding abdominal aortic applications of CEUS, briefly elaborate on CEUS technique and safety and present cases in order to illustrate the added value in aortic pathologies. Conditions discussed include abdominal aortic aneurysm (AAA), aneurysm rupture, aneurysm surveillance after endovascular repair, dissection and aortitis.
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Affiliation(s)
- Vasileios Rafailidis
- Department of Radiology, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sasan Partovi
- Department of Radiology, Center for Interventional Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Alexander Dikkes
- Department of Vascular Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Dean A Nakamoto
- Department of Radiology, Center for Interventional Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Nami Azar
- Department of Radiology, Center for Interventional Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Daniel Staub
- Department of Vascular Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
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15
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Complications of Intravenous Substance Use Disorders (SUDs): A Multimodality Pictorial Essay for Cardiothoracic Radiologists. J Thorac Imaging 2017; 33:W1-W12. [PMID: 29257030 DOI: 10.1097/rti.0000000000000315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
With the growing substance use disorders epidemic in the United States, a wide range of complications may be seen in both the acute and chronic clinical setting. This article will use a multimodality approach to review complications of intravenous substance use that cardiothoracic radiologists are likely to encounter. Radiologists should be aware of these multisystem complications that can affect the cardiovascular, respiratory, and musculoskeletal systems in order to make an accurate and timely diagnosis, which can drastically alter the management of these patients.
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16
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Md Noh MSF, Abdul Rashid AM, Ar A, B N, Mohammed Y, A R E. Emphysematous aortitis: report of two cases and CT imaging findings. BJR Case Rep 2017; 3:20170006. [PMID: 30363220 PMCID: PMC6159202 DOI: 10.1259/bjrcr.20170006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/13/2017] [Accepted: 03/09/2017] [Indexed: 01/16/2023] Open
Abstract
Emphysematous aortitis is a rare condition that manifests through the presence of air within or surrounding the inflamed aorta. Aortic inflammation may result from either an infective or a non-infective cause. Recognition of this rare condition is important as the resultant clinical deterioration may be rapid and lead to inevitable death. Cross-sectional imaging, with its relatively wide availability, proves an important tool in the diagnosis and subsequent management of this condition. We report two such cases encountered in our centre, with particular focus on the imaging findings on CT.
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Affiliation(s)
- Mohamad Syafeeq Faeez Md Noh
- Department of Imaging, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan, Malaysia
| | - Anna Misyail Abdul Rashid
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan, Malaysia
| | - Aida Ar
- Department of Diagnostic Imaging, Hospital Serdang, Serdang, Malaysia
| | - Norafida B
- Department of Imaging, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan, Malaysia
| | - Yusri Mohammed
- Department of Diagnostic Imaging, Hospital Serdang, Serdang, Malaysia
| | - Ezamin A R
- Department of Imaging, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan, Malaysia
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Bier G, Kurucay M, Henes J, Xenitidis T, Preibsch H, Nikolaou K, Horger M. Monitoring Disease Activity in Patients with Aortitis and Chronic Periaortitis Undergoing Immunosuppressive Therapy by Perfusion CT. Acad Radiol 2017; 24:470-477. [PMID: 27955964 DOI: 10.1016/j.acra.2016.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 10/26/2016] [Accepted: 10/30/2016] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the role of perfusion CT for monitoring inflammatory activity in patients with aortitis and chronic periaortitis undergoing immunosuppressive therapy. MATERIALS AND METHODS Seventeen symptomatic patients (median age 68.5 years) who underwent perfusion-based computed tomography (CT) monitoring after diagnostic contrast-enhanced CT were retrospectively included in this study. Blood flow (BF), blood volume (BV), volume transfer constant (k-trans), time to peak, and mean transit time were determined by setting circular regions of interest in prominently thickened parts of the vessel wall or perfused surrounding tissue at sites where the perfusion CT color maps showed a maximum BF value. Differences in CT perfusion and, morphological parameters, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were tested for significance during therapy. RESULTS In all patients BF and BV dropped at second perfusion CT (P < 0.05). In aortitis patients, CRP dropped from 3.86 ± 5.31 mg/dL to 0.9 ± 1.37 mg/dL and in periaortitis patients from 1.78 ± 2.25 mg/dL to 0.79 ± 1.55 mg/dL, whereas ESR dropped from 45.71 ± 37.59 seconds to 8.57 ± 3.1 seconds and 36.78 ± 34.67 seconds to 17.22 ± 21.82 seconds in aortitis and in periaortitis, respectively. CONCLUSIONS The course of perfusion CT parameters in aortitis and chronic periaortitis undergoing immunosuppressive therapy dropped at different extent after therapy.
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Affiliation(s)
- Georg Bier
- Department of Neuroradiology, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, Tübingen 72076, Germany.
| | - Mustafa Kurucay
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Jörg Henes
- Department of Internal Medicine-Oncology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Theodoros Xenitidis
- Department of Internal Medicine-Oncology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Heike Preibsch
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Marius Horger
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tübingen, Tübingen, Germany
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Lian K, Lee L, Machan L. Syphilitic Aortitis with Coronary Ostial Involvement: AIRP Best Cases in Radiologic-Pathologic Correlation. Radiographics 2017; 37:407-412. [PMID: 28287939 DOI: 10.1148/rg.2017160168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kevin Lian
- From the Department of Radiology (K.L., L.M.) and Department of Pathology and Laboratory Medicine (L.L.), University of British Columbia, 3350-950 W 10th Ave, Vancouver, BC, Canada V5Z 1M9
| | - Lawrence Lee
- From the Department of Radiology (K.L., L.M.) and Department of Pathology and Laboratory Medicine (L.L.), University of British Columbia, 3350-950 W 10th Ave, Vancouver, BC, Canada V5Z 1M9
| | - Lindsay Machan
- From the Department of Radiology (K.L., L.M.) and Department of Pathology and Laboratory Medicine (L.L.), University of British Columbia, 3350-950 W 10th Ave, Vancouver, BC, Canada V5Z 1M9
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Riambau V, Böckler D, Brunkwall J, Cao P, Chiesa R, Coppi G, Czerny M, Fraedrich G, Haulon S, Jacobs M, Lachat M, Moll F, Setacci C, Taylor P, Thompson M, Trimarchi S, Verhagen H, Verhoeven E, ESVS Guidelines Committee, Kolh P, de Borst G, Chakfé N, Debus E, Hinchliffe R, Kakkos S, Koncar I, Lindholt J, Vega de Ceniga M, Vermassen F, Verzini F, Document Reviewers, Kolh P, Black J, Busund R, Björck M, Dake M, Dick F, Eggebrecht H, Evangelista A, Grabenwöger M, Milner R, Naylor A, Ricco JB, Rousseau H, Schmidli J. Editor's Choice – Management of Descending Thoracic Aorta Diseases. Eur J Vasc Endovasc Surg 2017; 53:4-52. [DOI: 10.1016/j.ejvs.2016.06.005] [Citation(s) in RCA: 598] [Impact Index Per Article: 85.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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20
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Yoon J, Gruboy IPC, Zaid A, Salil SG, Connolly M, Aronow WS, Elozomor W, Zuberi J. Isolated idiopathic aortitis with an unusually thickened aortic wall: case report. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:428. [PMID: 27942519 DOI: 10.21037/atm.2016.11.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Aortitis includes a broad range of disorders involving inflammation of the aorta. While most forms of aortitis can be linked to a specific cause, patients with idiopathic aortitis (IDA), are asymptomatic and usually diagnosed after surgical removal. The specific pathophysiology is not well understood, but can be strongly associated with tobacco smoking, young age at presentation, and family history of aortic aneurysm. Wall thickening is the most common physical characteristic of aortitis, and the inflammation can affect any layer of the aorta. The normal wall thickness of the aorta is less than 4 mm and can be as thick as 9 mm. Few studies document a correlation between wall thickness and the severity of aortitis. This paper presents a unique case of severe aortic aneurysm associated with an abnormal thickening of the ascending aorta.
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Affiliation(s)
- John Yoon
- Department of Cardiothoracic Surgery, New York Medical College at Saint Joseph's, Paterson, NJ, USA
| | - Irina Pa-C Gruboy
- Department of Cardiothoracic Surgery, New York Medical College at Saint Joseph's, Paterson, NJ, USA
| | - Altheeb Zaid
- Department of Cardiovascular Medicine, New York Medical College at Saint Joseph's, Paterson, NJ, USA
| | - Shah G Salil
- Department of Cardiothoracic Surgery, Aria Jefferson Health/Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - Mark Connolly
- Department of Cardiothoracic Surgery, New York Medical College at Saint Joseph's, Paterson, NJ, USA
| | - Wilbert S Aronow
- Department of Medicine, Division of Cardiology, New York Medical College, Valhalla, NY, USA
| | - Walid Elozomor
- Department of Cardiothoracic Surgery, New York Medical College at Saint Joseph's, Paterson, NJ, USA
| | - Jamshed Zuberi
- Department of Cardiothoracic Surgery, New York Medical College at Saint Joseph's, Paterson, NJ, USA
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21
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Lariviere D, Benali K, Coustet B, Pasi N, Hyafil F, Klein I, Chauchard M, Alexandra JF, Goulenok T, Dossier A, Dieude P, Papo T, Sacre K. Positron emission tomography and computed tomography angiography for the diagnosis of giant cell arteritis: A real-life prospective study. Medicine (Baltimore) 2016; 95:e4146. [PMID: 27472684 PMCID: PMC5265821 DOI: 10.1097/md.0000000000004146] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The use of 18F-fluoro-deoxyglucose positron emission tomography scan (FDG-PET) and computed tomography angiography (CTA) to improve accuracy of diagnosis of giant cell arteritis (GCA) is a very important clinical need. We aimed to compare the diagnostic performance of FDG-PET and CTA in patients with GCA.FDG-PET and CTA were acquired in all consecutive patients suspected for GCA. Results of FDG-PET and CTA were compared with the final diagnosis based on clinical judgment, temporal artery biopsy (TAB) findings, and ACR criteria. Sensitivity, specificity, and positive and negative predictive values (PPV, NPV) were calculated for each method.Twenty-four patients suspected for GCA were included. Fifteen (62.5%) were ultimately diagnosed as having GCA. Among them, all fulfilled ACR criteria and 6 had biopsy-proven GCA. Strong FDG uptake in large vessels was found in 10 patients who all had GCA. Mean maximal standard uptake values (SUVmax) per patient measured at all the arterial territories were of 3.7 (range: 2.8-4.7). FDG uptake was negative in 14 patients including 9 and 5 patients without and with GCA, respectively. Mural thickening suggestive of aortitis or branch vessel arteritis was observed on CTA in 11 patients with and 2 patients without GCA. No mural thickening was observed in 11 patients including 7 patients without and 4 patients with GCA. Overall, sensitivity was 66.7% and 73.3%, specificity was 100% and 84.6%, NPV was 64.3% and 64.6%, and PPV was 100% and 84.6% of FDG-PET and CTA, respectively.Both FDG-PET and CTA have a strong diagnostic yield for the diagnosis of GCA. FDG-PET appeared to have a higher PPV as compared to CTA and may be the preferred noninvasive technique to explore patients with suspected GCA.
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Affiliation(s)
| | | | | | - Nicoletta Pasi
- Département de Radiologie, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité
| | | | - Isabelle Klein
- Département de Radiologie, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité
| | - Maria Chauchard
- Département de Médecine Interne, Hôpital Saint Antoine, Université Pierre et Marie Curie, Assistance Publique Hôpitaux de Paris
| | | | | | | | - Philippe Dieude
- Département de Rhumatologie
- INSERM U1149
- Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation and Remodelling in Renal and Respiratory Diseases), Université Paris Diderot, PRES Sorbonne Paris Cité, Paris, France
| | - Thomas Papo
- Département de Médecine Interne
- INSERM U1149
- Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation and Remodelling in Renal and Respiratory Diseases), Université Paris Diderot, PRES Sorbonne Paris Cité, Paris, France
| | - Karim Sacre
- Département de Médecine Interne
- INSERM U1149
- Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation and Remodelling in Renal and Respiratory Diseases), Université Paris Diderot, PRES Sorbonne Paris Cité, Paris, France
- Correspondence: Professor Karim Sacre, Department of Internal Medicine, Assistance Publique Hopitaux de Paris, University Paris Diderot, 46 rue Henri Huchard, 75018, Paris, France (e-mail: )
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Pérez Ruiz J, Salman-Monte TC, Pros-Simón A, Mestre-Fusco A, Carbonell i Abellò J. Vasculitis aórtica en un paciente con lupus eritematoso sistémico. ACTA ACUST UNITED AC 2016; 12:169-72. [DOI: 10.1016/j.reuma.2015.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 05/18/2015] [Accepted: 05/25/2015] [Indexed: 10/23/2022]
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Schmidt J, Duhaut P. Atteinte aortique dans la maladie de Horton. Rev Med Interne 2016; 37:239-44. [DOI: 10.1016/j.revmed.2015.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 11/12/2015] [Accepted: 12/21/2015] [Indexed: 01/16/2023]
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24
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Multimodality Noninvasive Imaging of Thoracic Aortic Aneurysms: Time to Standardize? Can J Cardiol 2016; 32:48-59. [DOI: 10.1016/j.cjca.2015.09.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 09/10/2015] [Accepted: 09/11/2015] [Indexed: 01/16/2023] Open
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Loricera J, Blanco R, Hernández J, Martínez-Rodríguez I, Carril J, Lavado C, Jiménez M, González-Vela C, González-Gay M. Use of positron emission tomography (PET) for the diagnosis of large-vessel vasculitis. Rev Esp Med Nucl Imagen Mol 2015. [DOI: 10.1016/j.remnie.2015.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bier G, Henes J, Eulenbruch C, Xenitidis T, Nikolaou K, Horger M. Perfusion-based assessment of disease activity in untreated and treated patients with aortitis and chronic periaortitis: correlation with CT morphological, clinical and serological data. Br J Radiol 2015; 88:20150526. [PMID: 26423599 DOI: 10.1259/bjr.20150526] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To evaluate the role of perfusion-based assessment of inflammatory activity in patients with treated and untreated aortitis and chronic periaortitis as compared with clinical and serological markers. METHODS 35 patients (20 females; median age 66 years) with (peri) aortitis were retrospectively evaluated. All patients had clinical symptoms prompting at the time of imaging. All patients first underwent whole-body contrast-enhanced CT and subsequently segmental volume perfusion CT for assessment of the degree of vascularization of (peri) aortitis as a surrogate marker for inflammatory activity. Blood flow, blood volume, volume transfer constant (k-trans), time to peak and mean transit time were determined. The thickness of the increased connective tissue formation was measured. Perfusion data were correlated with clinical symptoms and acute-phase inflammatory parameters such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and leukocyte number. RESULTS 21 of 35 patients were untreated and 14 of 35 had previous/ongoing immunosuppression. The interobserver agreement was good (κ = 0.78) for all perfusion parameters. Average values of perfusion parameters were higher in untreated patients but remained abnormally elevated in treated patients as well. Perfusion data and ESR and CRP correlated well both in aortitis (p < 0.05) and in periaortitis (p < 0.05). In periaortitis, perfusion parameters agreed well with ESR and CRP values (p < 0.05) only in untreated patients. CONCLUSION Perfusion CT parameters in untreated aortitis and chronic periaortitis correlate well with serological markers with respect to disease activity assessment. However, in treated periaortitis, correlations were weak, suggesting an increased role for (perfusion-based) imaging. ADVANCES IN KNOWLEDGE Volume perfusion CT may be used for diagnosis of aortitis/periaortitis.
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Affiliation(s)
- Georg Bier
- 1 Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen, Germany
| | - Jörg Henes
- 2 Department of Internal Medicine-Oncology, Eberhard Karls University, Tübingen, Germany
| | - Carolin Eulenbruch
- 1 Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen, Germany
| | - Theodoros Xenitidis
- 2 Department of Internal Medicine-Oncology, Eberhard Karls University, Tübingen, Germany
| | - Konstantin Nikolaou
- 1 Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen, Germany
| | - Marius Horger
- 1 Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen, Germany
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27
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Reimer P, Vosshenrich R, Storck M. [Acute aortic diseases. Diagnostic imaging and therapy]. Radiologe 2015; 55:803-15, quiz 816. [PMID: 26336960 DOI: 10.1007/s00117-015-0010-9] [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: 11/30/2022]
Abstract
Diagnostic imaging is crucial in the work-up of acute aortic diseases. Current imaging algorithms enable radiologists differentiating the various entities with subsequent clinically relevant treatment options. Within this educational overview we focus on non-traumatic acute aortic disease. Recent developments of cross sectional imaging are summarized. As for acute aortic disease, we discuss dissections, intramural hematoma, penetrating aortic ulcer, and aortitis. Current treatment options are presented.
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Affiliation(s)
- P Reimer
- Institut für diagnostische und interventionelle Radiologie, Klinikum Karlsruhe, Moltkestraße 90, 79133, Karlsruhe, Deutschland.
| | - R Vosshenrich
- Praxis für moderne Schnittbild-Diagnostik, Bahnhofsallee 1d, 37081, Göttingen, Deutschland
| | - M Storck
- Klinik für Gefäß- und Thoraxchirurgie, Klinikum Karlsruhe, Moltkestraße 90, 79133, Karlsruhe, Deutschland
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28
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Use of positron emission tomography (PET) for the diagnosis of large-vessel vasculitis. Rev Esp Med Nucl Imagen Mol 2015; 34:372-7. [PMID: 26272121 DOI: 10.1016/j.remn.2015.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 07/06/2015] [Indexed: 10/23/2022]
Abstract
The term vasculitis encompasses a heterogeneous group of diseases that share the presence of inflammatory infiltrates in the vascular wall. The diagnosis of large-vessel vasculitis is often a challenge because the presenting clinical features are nonspecific in many cases and they are often shared by different types of autoimmune and inflammatory diseases including other systemic vasculitides. Moreover, the pathogenesis of large-vessel vasculitis is not fully understood. Nevertheless, the advent of new imaging techniques has constituted a major breakthrough to establish an early diagnosis and a promising tool to monitor the follow-up of patients with largevessel vasculitis. This is the case of the molecular imaging with the combination of positron emission tomography with computed tomography (PET/CT) using different radiotracers, especially the (18)F-fluordeoxyglucose ((18)F-FDG). In this review we have focused on the contribution of (18)F-FDG PET in the diagnosis of large-vessel vasculitis.
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29
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Manlove W, Raptis CA, Bhalla S. Pitfalls in computed tomography of the aorta. Semin Roentgenol 2015; 50:229-34. [PMID: 26002244 DOI: 10.1053/j.ro.2015.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Whitney Manlove
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
| | - Constantine A Raptis
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
| | - Sanjeev Bhalla
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO.
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Foley J, Mullan D, Mohan H, Schmidt K. Abdominal aortitis on PET CT: A case report and review of the literature. Int J Surg Case Rep 2015; 10:104-6. [PMID: 25827296 PMCID: PMC4429952 DOI: 10.1016/j.ijscr.2015.02.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 02/09/2015] [Accepted: 02/16/2015] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Aortitis often occurs in patients with systemic vasculitis. PRESENTATION OF CASE We reported a 73 year old man with giant cell arteritis who was presented with abdominal pain and weight loss. DISCUSSION Aortitis was diagnosed on PET-CT scan performed because initial investigations raised the possibility of pancreatic pathology. CONCLUSION This case highlights the utility of PET-CT in the diagnosis of abdominal aortitis and the need to consider aortitis as a differential in patients with abdominal pain with a history of vasculitis.
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Affiliation(s)
- J Foley
- Department of Surgery, Wexford General Hospital, Wexford, Ireland.
| | - D Mullan
- Department of Surgery, Wexford General Hospital, Wexford, Ireland
| | - H Mohan
- Department of Surgery, Wexford General Hospital, Wexford, Ireland
| | - K Schmidt
- Department of Surgery, Wexford General Hospital, Wexford, Ireland
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31
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Penna D, Testa C, Arena V, Pelosi E. 18F-FDG-PET/CT in a Patient with Suspected Large Vessel Vasculitis. J Clin Diagn Res 2014; 8:RJ02-3. [PMID: 25478429 DOI: 10.7860/jcdr/2014/8283.5035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 08/28/2014] [Indexed: 11/24/2022]
Affiliation(s)
- Daniele Penna
- Nuclear Medicine Physician, IRMET S.P.A. Euromedic PET/CT Center , Via Onorato Vigliani 89, Zip Code 10135, Turin, Italy
| | - Claudio Testa
- Radiology Technician, IRMET S.P.A. Euromedic PET/CT Center , Via Onorato Vigliani 89, Zip Code 10135, Turin, Italy
| | - Vincenzo Arena
- Nuclear Medical Physician, IRMET S.P.A. Euromedic PET/CT Center , Via Onorato Vigliani 89, Zip Code 10135, Turin, Italy
| | - Ettore Pelosi
- Nuclear Medical Physician, IRMET S.P.A. Euromedic PET/CT Center , Via Onorato Vigliani 89, Zip Code 10135, Turin, Italy
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Hartlage GR, Palios J, Barron BJ, Stillman AE, Bossone E, Clements SD, Lerakis S. Multimodality Imaging of Aortitis. JACC Cardiovasc Imaging 2014; 7:605-19. [DOI: 10.1016/j.jcmg.2014.04.002] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 03/11/2014] [Accepted: 04/04/2014] [Indexed: 02/08/2023]
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Cabero Moyano J, Andreu Magarolas M, Castañer González E, Gallardo Cistaré X, Belmonte Castan E. Patología aórtica no urgente: diagnóstico clínico-radiológico de la aortitis. RADIOLOGIA 2013; 55:469-82. [DOI: 10.1016/j.rx.2013.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 04/09/2013] [Accepted: 05/04/2013] [Indexed: 12/26/2022]
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Nonurgent aortic disease: Clinical-radiological diagnosis of aortitis. RADIOLOGIA 2013. [DOI: 10.1016/j.rxeng.2013.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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35
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Raman SP, Fishman EK. Mycotic aneurysms: a critical diagnosis in the emergency setting. Emerg Radiol 2013; 21:191-6. [DOI: 10.1007/s10140-013-1168-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 10/08/2013] [Indexed: 12/28/2022]
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