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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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2
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Virmani R, Sato Y, Sakamoto A, Romero ME, Butany J. Aneurysms of the aorta: ascending, thoracic, and abdominal and their management. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00009-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Pesce A, Armocida D, Petrella G, Guerrini F, Pompucci A. Vertebral body erosion by a chronic contained rupture of thoraco-abdominal aortic aneurysm: systematic review and spine surgical recommendations. World Neurosurg 2021; 158:e75-e86. [PMID: 34737100 DOI: 10.1016/j.wneu.2021.10.116] [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: 09/05/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Vertebral body erosion (VBE) is commonly caused by neoplastic, inflammatory or infectious diseases: it can be rarely associated with aortic wall disorders, such as contained rupture of aortic aneurysm (CCR-AA). CCR-AA is a rare event consisting of less than 5% of all reported cases. This condition is easily undiagnosed, differential diagnosis may be challenging, and there is no consensus or recommendation that dictates guidance on management of spinal surgical treatment. MATERIAL AND METHODS We performed a systematic review of literature of all cases of VBE secondary to CCR-AA to identify clinical, radiological, and surgical outcome characteristics with the aim of providing a basis for future research studies. RESULTS The search returned a total of 80 patients. All reported cases have a history of hypertension. In almost all cases the AA size reported was very high (mean diameter of 7.056 cm). The treatment of this condition involves various reported treatment strategies: a totally conservative approach, treatment of the aortic aneurysm through a minimally invasive endovascular procedure, or through open surgery and combined approach. Despite the wide variability in therapeutic strategy, the rate of good outcomes was 80%, relatively high. CONCLUSIONS ''Back pain'' and pain along the vertebral column are such frequent complaints that unusual etiologies or serious and life threatening complications may be overlooked. In addition to the common traumatic and degenerative causes of back pain, AA must also be considered. A combined approach between vascular and spine surgery could be achieved without any increased risk.
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Affiliation(s)
| | - Daniele Armocida
- Santa Maria Goretti Hospital, Latina (LT), Italy; Human Neurosciences Department Neurosurgery Division "Sapienza" University.
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4
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de Souza NLAR, Siqueira DED, Cantador AA, Rossetti LP, Molinari GJDP, Guillaumon AT. Tratamento endovascular de aneurisma de aorta abdominal com erosão de vértebra lombar associada à doença de Behçet: relato de caso. J Vasc Bras 2017; 16:162-167. [PMID: 29930640 PMCID: PMC5915864 DOI: 10.1590/1677-5449.009416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A doença de Behçet é uma doença sistêmica, multifatorial e autoimune com diversas manifestações clínicas, entre elas o acometimento vascular. Aneurisma de aorta associado a erosão de vértebra lombar é condição rara na literatura, existindo apenas quatro relatos de caso nas bases de dados da PubMed. O presente artigo relata o caso de paciente do sexo feminino com diagnóstico de Doença de Behçet de longa data e aneurisma sacular de aorta abdominal infrarrenal com erosão de vértebra lombar. O caso foi tratado por meio de técnica endovascular com colocação de endoprótese monoilíaca e enxerto fêmoro-femoral cruzado, devido a limitações anatômicas da bifurcação aórtica. O artigo aborda a raridade desse tipo de apresentação da doença e o desfecho do tratamento e apresenta revisão da literatura sobre esse tema.
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Ladich E, Butany J, Virmani R. Aneurysms of the Aorta. Cardiovasc Pathol 2016. [DOI: 10.1016/b978-0-12-420219-1.00005-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Jiménez Viseu Pinheiro JF, Blanco Blanco JF, Pescador Hernández D, García García FJ. Vertebral destruction due to abdominal aortic aneurysm. Int J Surg Case Rep 2014; 6C:296-9. [PMID: 25569196 PMCID: PMC4334888 DOI: 10.1016/j.ijscr.2014.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 12/02/2014] [Indexed: 11/25/2022] Open
Abstract
Low back pain is a common cause of medical consultation, and usually supposes a non-malignant prognostic. We report an abdominal aortic aneurism (AAA) as atypical etiology of low back pain. We should consider AAA as other cause of low back pain and routinely examine the abdomen and seek complementary imaging proves when risk factors for AAA are present. Orthopedic surgery for back spine stabilization has to be elective in those cases when vertebral destruction is above 30% and clinic is directly related to spine instability.
Introduction Low back pain is a common cause of medical consultation, and usually supposes a non-malignant prognostic. Presentation of case We report an atypical appearance of low back pain associated to shock and pulsatile abdominal mass that made us diagnose an abdominal aortic aneurysm as reason of vertebral lysis and pain. Discusion Surgical repair of contained AAA should be directed to secondary re-rupture prevention, with an approximate survival near to 100% at selected patients for elective surgery. Consequently, orthopedic surgery for back spine stabilization has to be elective in those cases when vertebral destruction is above 30% and clinic is directly related to spine instability. Conclusion We should consider AAA as other cause of low back pain and routinely examine the abdomen and seek complementary imaging proves when risk factors for AAA are present.
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Affiliation(s)
- J F Jiménez Viseu Pinheiro
- Department of trauma and orthopedics surgery, Spine Unit, University Hospital of Salamanca, IBSAL, Spain.
| | - J F Blanco Blanco
- Department of trauma and orthopedics surgery, Spine Unit, University Hospital of Salamanca, IBSAL, Spain
| | - D Pescador Hernández
- Department of trauma and orthopedics surgery, Spine Unit, University Hospital of Salamanca, IBSAL, Spain
| | - F J García García
- Department of trauma and orthopedics surgery, Spine Unit, University Hospital of Salamanca, IBSAL, Spain
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Abdominal aortic aneurysm causing lumbar vertebral erosion in Behçet's disease presenting by low back pain. Rheumatol Int 2014; 35:367-70. [PMID: 24957970 DOI: 10.1007/s00296-014-3077-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 06/13/2014] [Indexed: 11/27/2022]
Abstract
Behçet's disease (BD) is a chronic multi-system disorder commonly seen in Mediterranean, middle east and far eastern populations. In this report, we describe a case of a 55-year-old male with Behçet's disease who presented with a low back pain and sciatica. Imaging studies showed that he had a destruction of the third lumbar vertebra because of abdominal aortic aneurysm-related Behçet's disease. Aortic aneurysms with vertebral body erosion have been rarely reported, but this vascular complication is a life-threatening clinical picture. Therefore, among the causes of chronic lumbar pain in a BD patient, abdominal aortic aneurysm should be remembered.
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[Vertebral erosions in abdominal aortic aneurysms as a cause of chronic low back pain. A series of 5 cases]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2013; 56:478-81. [PMID: 23594945 DOI: 10.1016/j.recot.2012.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 07/22/2012] [Indexed: 11/23/2022] Open
Abstract
Chronic low back bain is a common cause of medical consultation, and is often associated with degenerative vetebral disease. Despite this, we must not forget other diseases even in those cases where the imaging tests may suggest chronic degenerative changes in the lumbar spine, including the possible presence of an abdominal aortic aneurysm with a contained rupture must be ruled out due to its prognostic and therapeutic implications. We present 5 cases of chronic low back pain associated with serious lytic lesions in the vertebral body due to chronic rupture of an abdominal aortic aneurysm.
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Massive vertebral destruction associated with chronic rupture of infrarenal aortic aneurysm: case report and systematic review of the literature in the English language. Spine (Phila Pa 1976) 2012; 37:E1665-71. [PMID: 22990367 DOI: 10.1097/brs.0b013e318273dc66] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case report and review of literature. OBJECTIVE To highlight the specific features of a rare, life-threatening, clinical picture. SUMMARY OF BACKGROUND DATA Vertebral erosion (VE) is rarely associated with contained rupture of an abdominal aortic aneurysm. The involvement of radicular nerves can mimic a discus hernia syndrome; eventually vertebral erosion induces isolated lower back pain. These features often lead to a delayed or wrong diagnosis of a life-threatening condition. Forty-two complete similar case reports have been published in the English literature since 1962. The most prevalent symptoms are low back pain and neurological signs due to compression of radicular nerves. METHODS A 73-year-old man presented to Vascular Surgery department complaining of continuous pain in the lumbar region during the previous 6 months. The duplex examination revealed a huge infrarenal aortic aneurysm with an undefined posterior wall. Spiral CT and MR scan confirmed the aneurysm and a scalloping of the second and third lumbar vertebral bodies. RESULTS A double-team intervention, vascular and orthopedic, consisted in aneurysm graft replacement; vertebral bodies excision and anterior and posterior spinal stabilization. Postoperatively the patient experienced reversible respiratory and renal failure and was discharged home in good health after 30 days. CONCLUSION The presence of aortic abdominal aneurysm is always to be considered in the evaluation of an elderly patient complaining lower back pain or lower limb neuropathy of recent onset, especially in the presence of a degenerative process of the spine.
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González Gay M, Alonso Pérez M, Adeba Vallina E. Vertebral erosions in abdominal aortic aneurysms as a cause of chronic low back pain. A series of 5 cases. Rev Esp Cir Ortop Traumatol (Engl Ed) 2012. [DOI: 10.1016/j.recote.2012.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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11
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Repetitive contained rupture of an infected abdominal aortic aneurysm with concomitant vertebral erosion. Ann Vasc Surg 2010; 24:824.e1-5. [PMID: 20471795 DOI: 10.1016/j.avsg.2010.02.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Revised: 09/20/2009] [Accepted: 02/11/2010] [Indexed: 11/23/2022]
Abstract
We describe a rare case of surgical treatment for a repeated contained rupture of an infected abdominal aortic aneurysm (AAA) with concomitant vertebral erosion. A 59-year-old man presented to a nearby hospital with abdominal pain and fever. On admission, computed tomography (CT) scan revealed a contained rupture of AAA, but the patient declined the offer of surgical therapy. Thereafter, the retroperitoneal hematoma gradually reduced in size. The third and fourth lumbar vertebrae were eroded on the CT scan 12 months after the appearance of the first symptom. However, 21 months after the first symptom, he suffered severe lumbago and was diagnosed with recurrence of contained AAA rupture and vertebral body destruction. He underwent debridement of eroded vertebrae and in situ graft replacement of AAA with omentum flap wrapping. Intraoperative microscopic examination of the hematoma revealed gram-positive Streptococcus. His postoperative course was uneventful, and CT 12 months after surgery did not reveal further deterioration of vertebral erosion or fluid accumulation. Repetitive contained AAA rupture may be another entity in contrast to chronic contained AAA rupture. Vertebral erosion could be associated with infection rather than mass effects of the contained hematoma. Surgical treatment is indicated to prevent life-threatening re-rupture and severe spinal instability.
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12
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Ahn HJ, Kwon SH, Park HC. Abdominal aortic aneurysm rupture with vertebral erosion presenting with severe refractory back pain in Behçet's disease. Ann Vasc Surg 2009; 24:254.e17-9. [PMID: 19900780 DOI: 10.1016/j.avsg.2009.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Accepted: 05/27/2009] [Indexed: 11/28/2022]
Abstract
Behçet's disease is a chronic recurrent inflammatory disorder that affects many organs. A 48-year-old man with known Behçet's disease was admitted to the emergency department with aggravating severe back pain and left lower quadrant pain. A contained rupture of infrarenal abdominal aortic aneurysm (AAA) was discovered with a maximum diameter of 10 cm. The patient's severe back pain was due to erosion of the third lumbar vertebra.
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Affiliation(s)
- Hyung Joon Ahn
- Department of Surgery, Kyunghee University School of Medicine, Seoul, South Korea.
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13
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Marzban M, Mandegar MH, Karimi A, Abbasi K, Movahedi N, Navabi MA, Abbasi SH, Moshtaghi N. Cardiac and great vessel involvement in "Behcet's disease". J Card Surg 2009; 23:765-8. [PMID: 19017008 DOI: 10.1111/j.1540-8191.2008.00607.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Behcet's disease is a multisystem disorder and classified as "vasculitic syndrome with a wide variety of clinical manifestations." Cardiac involvement is very rare but can occur with different presentations including: pericarditis, cardiomyopathy, endocarditis, endomyocardial fibrosis, intracavitary thrombosis, and coronary artery disease. Great vessel involvement is more common. Recurrent Phlebitis, commonly involving large vessels (superior vena cava, inferior vena cava, hepatic veins) and cerebral veins are the sole presentation in this regard. Arterial involvement is expressed by aneurysm or pseudoaneurysmal formation. Due to the wide variety of cardiovascular manifestations and the resulting high mortality, cardiac surgeons should be familiar with this disease. In this paper we review the articles and introduce our four cases presenting with aneurysm of ascending aorta with free aortic insufficiency, aneurysm of descending aorta, pulmonary artery aneurysm, and pseudoaneurysm of aortic arch.
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Affiliation(s)
- Mehrab Marzban
- Tehran Heart Center, Medical Sciences, University of Tehran, Tehran, Iran.
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Barros M, Lozano F, Almazán A, Arias R. Angio-Behçet with vertebral erosion: an exceptional Behçet’s complication and literature review. Joint Bone Spine 2004; 71:577-9. [PMID: 15589443 DOI: 10.1016/j.jbspin.2003.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2003] [Accepted: 08/22/2003] [Indexed: 11/30/2022]
Abstract
Behçet's disease is a multisystem disorder commonly seen in Japan and in Mediterranean countries characterized by a vasculitis of unknown origin. In this work, we describe a case of a 47-year-old man with Behçet's disease of 28 years evolution who presented with a common lumbago and revealed to have a rare case of destruction of the third lumbar vertebra due to a giant pseudoaneurysm of the right iliac artery. In the discussion, we make a brief review of the literature on the subject and analyze the existence of three similar cases.
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Affiliation(s)
- Marcello Barros
- Vascular Surgery Unit of the University Hospital of Salamanca, University of Salamanca, Paseo de San Vicente s/n, 37007 Salamanca, Spain.
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Akpolat T, Danaci M, Belet U, Erkan ML, Akar H. MR imaging and MR angiography in vascular Behçet's disease. Magn Reson Imaging 2000; 18:1089-96. [PMID: 11118763 DOI: 10.1016/s0730-725x(00)00215-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aims of this study are to demonstrate the ability of magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) in the diagnosis and evaluation of vascular involvement in Behçet's disease. Twelve patients with vascular involvement due to Behçet's disease were included in this study. We believe that MRI and MRA are safe and noninvasive methods that can be used to confirm and monitor vascular Behçet's disease.
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Affiliation(s)
- T Akpolat
- Department of Internal Medicine, The Institute, Ondokuz Mayis University, School of Medicine, 55139, Samsun, Turkey.
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