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El Hoyek N, Chen W, Aktay R. Infectious Aortitis on 18 F-FDG PET/CT. Clin Nucl Med 2024; 49:866-867. [PMID: 38968548 DOI: 10.1097/rlu.0000000000005354] [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: 07/07/2024]
Abstract
ABSTRACT Infectious aortitis is a challenging radiographic diagnosis due to overlapping features with the noninfectious category. We present a case of a 58-year-old woman who tested positive for SARS-CoV-2 and Streptococcus pneumoniae bacteremia. 18 F-FDG PET/CT demonstrated large vessel vasculitis involving the thoracic, abdominal aorta, and the brachiocephalic branches of the aortic arch, and an incidental subcutaneous abscess in the right arm. Standard of care treatment was administered. Within a week, a drastic improvement of the wall thickening was noted, which can be, regardless of the biological markers, a surrogate marker of an infectious aortitis.
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Affiliation(s)
- Nadine El Hoyek
- From the Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, School of Medicine, University of Maryland, Baltimore, MD
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2
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Manenti A, Roncati L, Sorrentino L, Farinetti A, Borri M, Manco G, Coppi G, Mattioli AV, Gelmini R, Coppi F. Thoracic aortic pseudoaneurysm: Inside its pathophysiology. Vascular 2024:17085381241273314. [PMID: 39118321 DOI: 10.1177/17085381241273314] [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: 08/10/2024]
Abstract
OBJECTIVES Our aim was to investigate pathophysiology of pseudoaneurysm of the thoracic aorta, an acute or chronic pathology, respectively, secondary to blunt thoracic trauma and aortitis, or complicating a deep penetrating aortic ulcer, intraparietal hematoma, aortic aneurysm, and even aortic graft, often with atherosclerosis as a common background. METHODS Given the relative rarity of this disease, an "inductive" retrospective method made it possible to retrieve clinical, radiological, and histopathological elements, which were mutually compared and validated through a "deductive" process of reinterpretation. RESULTS We have identified three main structural constituents of this disease: a cavity, a single blood entry port, communicating with the aortic lumen, and a pseudocapsule. It is often caused by a chronic degenerative pathology of the intima and medial layers of the aorta, typically involving elastic fibers and smooth muscle cells, with possible intermediate stages of deep aortic ulcer or intraparietal hematoma. Otherwise, the acute onset may be secondary to acute aortitis or aortic injury. CONCLUSIONS Today, thanks to the current angiographic tools represented by 3-D high resolution multidetector CT and MRI angiography, the diagnosis of thoracic aortic pseudoaneurysm is easier, as well as its surgical indications.
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Affiliation(s)
- Antonio Manenti
- Departments of Surgery, University of Modena and Reggio Emilia, Italy
| | - Luca Roncati
- Departments of Pathology, University of Modena and Reggio Emilia, Italy
| | - Lorena Sorrentino
- Departments of Surgery, University of Modena and Reggio Emilia, Italy
| | - Alberto Farinetti
- Departments of Surgery, University of Modena and Reggio Emilia, Italy
| | - Massimo Borri
- Departments of Surgery, University of Modena and Reggio Emilia, Italy
| | - Giuseppe Manco
- Departments of Surgery, University of Modena and Reggio Emilia, Italy
| | - Giovanni Coppi
- Departments of Surgery, University of Modena and Reggio Emilia, Italy
| | | | - Roberta Gelmini
- Departments of Surgery, University of Modena and Reggio Emilia, Italy
| | - Francesca Coppi
- Departments of Cardiology, University of Modena and Reggio Emilia, Italy
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3
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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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4
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Hankard A, Maalouf G, Laouni J, Espitia O, Agard C, De Boysson H, Aouba A, Sacré K, Papo T, Leroux G, Vautier M, Desbois AC, Domont F, Le Joncour A, Mirouse A, Chiche L, Skaff Y, Gaudric J, Boussouar S, Redheuil A, Bravetti M, Cacoub P, Saadoun D. Outcome and prognosis of isolated carotid vasculitis. J Autoimmun 2024; 146:103242. [PMID: 38761452 DOI: 10.1016/j.jaut.2024.103242] [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: 11/24/2023] [Revised: 04/12/2024] [Accepted: 05/03/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVE To assess the prognosis and outcome of patients with isolated carotid vasculitis. METHODS We performed a retrospective multicenter study of 36 patients (median age at diagnosis was 37 [IQR 27-45] years and 11 [31 %] patients were men) with initial presentation as isolated carotid vasculitis. Study endpoints included vascular complications, relapses, and progression to large vessel vasculitis (i.e. Giant cell arteritis or Takayasu). RESULTS The most frequent involvement was the left internal carotid artery (39 %), and 81 % had stenosis. After a median follow-up of 32 months [IQR 12-96], 21 (58 %) patients had a vascular event, including 31 % of new onset vascular lesions and 25 % of stroke/transient ischemic attack. Patients with stroke had less carotidynia at diagnosis (33 % vs 74 %, p = 0.046), higher significant carotid stenosis (i.e. > 50 %) (89 % vs. 30 %, p = 0.026) and higher severe carotid stenosis (i.e. >70 %) (67 % vs 19 %, p = 0.012), compared to those without stroke. Twenty (52 %) patients experienced relapses. High CRP at diagnosis was associated with relapses (p = 0.022). At the end of follow-up, 21 (58 %) patients were classified as having Takayasu arteritis, 13 (36 %) as isolated carotid vasculitis, and two (6 %) as giant cell arteritis. CONCLUSION Carotid vasculitis may occur as a topographically limited lesion and is associated with significant rate of vascular complications.
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Affiliation(s)
- A Hankard
- Department of Internal Medicine, Caen University Hospital, Basse Normandie University, Caen, France
| | - G Maalouf
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Centre National de Références Maladies Autoimmunes et Systémiques Rares et Maladies Autoinflammatoires Rares, F-75013, Paris, France; Sorbonne Université, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), F-75005, Paris, France; Biotherapy (CIC-BTi), Hôpital Pitié-Salpêtrière, AP-HP, F-75651, Paris, France
| | - J Laouni
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Centre National de Références Maladies Autoimmunes et Systémiques Rares et Maladies Autoinflammatoires Rares, F-75013, Paris, France; Sorbonne Université, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), F-75005, Paris, France; Biotherapy (CIC-BTi), Hôpital Pitié-Salpêtrière, AP-HP, F-75651, Paris, France
| | - O Espitia
- Nantes University, CHU Nantes, Department of Internal Medicine, F-44000, Nantes, France
| | - C Agard
- Nantes University, CHU Nantes, Department of Internal Medicine, F-44000, Nantes, France
| | - H De Boysson
- Department of Internal Medicine, Caen University Hospital, Basse Normandie University, Caen, France
| | - A Aouba
- Department of Internal Medicine, Caen University Hospital, Basse Normandie University, Caen, France
| | - K Sacré
- Department of Internal Medicine, Hôpital Bichat, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; Plateforme de Cytométrie et d'Imagerie de Masse de Montpellier, IRCM, INSERM, Univ Montpellier, ICM, Montpellier, France; Université Paris Cité, Centre de Recherche sur l'Inflammation, INSERM, UMR1149, CNRS, ERL8252, Faculté de Médecine Site Bichat, Laboratoire d'Excellence Inflamex, Paris, France
| | - T Papo
- Department of Internal Medicine, Hôpital Bichat, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; Plateforme de Cytométrie et d'Imagerie de Masse de Montpellier, IRCM, INSERM, Univ Montpellier, ICM, Montpellier, France; Université Paris Cité, Centre de Recherche sur l'Inflammation, INSERM, UMR1149, CNRS, ERL8252, Faculté de Médecine Site Bichat, Laboratoire d'Excellence Inflamex, Paris, France
| | - G Leroux
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Centre National de Références Maladies Autoimmunes et Systémiques Rares et Maladies Autoinflammatoires Rares, F-75013, Paris, France; Sorbonne Université, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), F-75005, Paris, France; Biotherapy (CIC-BTi), Hôpital Pitié-Salpêtrière, AP-HP, F-75651, Paris, France
| | - M Vautier
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Centre National de Références Maladies Autoimmunes et Systémiques Rares et Maladies Autoinflammatoires Rares, F-75013, Paris, France; Sorbonne Université, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), F-75005, Paris, France; Biotherapy (CIC-BTi), Hôpital Pitié-Salpêtrière, AP-HP, F-75651, Paris, France
| | - A C Desbois
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Centre National de Références Maladies Autoimmunes et Systémiques Rares et Maladies Autoinflammatoires Rares, F-75013, Paris, France; Sorbonne Université, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), F-75005, Paris, France; Biotherapy (CIC-BTi), Hôpital Pitié-Salpêtrière, AP-HP, F-75651, Paris, France
| | - F Domont
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Centre National de Références Maladies Autoimmunes et Systémiques Rares et Maladies Autoinflammatoires Rares, F-75013, Paris, France; Sorbonne Université, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), F-75005, Paris, France; Biotherapy (CIC-BTi), Hôpital Pitié-Salpêtrière, AP-HP, F-75651, Paris, France
| | - A Le Joncour
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Centre National de Références Maladies Autoimmunes et Systémiques Rares et Maladies Autoinflammatoires Rares, F-75013, Paris, France; Sorbonne Université, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), F-75005, Paris, France; Biotherapy (CIC-BTi), Hôpital Pitié-Salpêtrière, AP-HP, F-75651, Paris, France
| | - A Mirouse
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Centre National de Références Maladies Autoimmunes et Systémiques Rares et Maladies Autoinflammatoires Rares, F-75013, Paris, France; Sorbonne Université, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), F-75005, Paris, France; Biotherapy (CIC-BTi), Hôpital Pitié-Salpêtrière, AP-HP, F-75651, Paris, France
| | - L Chiche
- Department of Vascular Surgery, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Y Skaff
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Centre National de Références Maladies Autoimmunes et Systémiques Rares et Maladies Autoinflammatoires Rares, F-75013, Paris, France; Sorbonne Université, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), F-75005, Paris, France; Biotherapy (CIC-BTi), Hôpital Pitié-Salpêtrière, AP-HP, F-75651, Paris, France
| | - J Gaudric
- Department of Vascular Surgery, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - S Boussouar
- Department of Cardiovascular Imaging, Interventional and Thoracic Radiology, Institute of Cardiology, Hôpital Pitié-Salpêtrière, Paris, France
| | - A Redheuil
- Department of Cardiovascular Imaging, Interventional and Thoracic Radiology, Institute of Cardiology, Hôpital Pitié-Salpêtrière, Paris, France
| | - M Bravetti
- Department of Cardiovascular Imaging, Interventional and Thoracic Radiology, Institute of Cardiology, Hôpital Pitié-Salpêtrière, Paris, France
| | - P Cacoub
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Centre National de Références Maladies Autoimmunes et Systémiques Rares et Maladies Autoinflammatoires Rares, F-75013, Paris, France; Sorbonne Université, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), F-75005, Paris, France; Biotherapy (CIC-BTi), Hôpital Pitié-Salpêtrière, AP-HP, F-75651, Paris, France
| | - D Saadoun
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Centre National de Références Maladies Autoimmunes et Systémiques Rares et Maladies Autoinflammatoires Rares, F-75013, Paris, France; Sorbonne Université, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), F-75005, Paris, France; Biotherapy (CIC-BTi), Hôpital Pitié-Salpêtrière, AP-HP, F-75651, Paris, France.
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5
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Zolio L, Francis PA, Ferdowsi N. PEG-GCSF-induced aortitis in a patient with breast cancer: distinguishing between infective and immune-mediated aortitis. Med J Aust 2024; 220:307-309. [PMID: 38379291 DOI: 10.5694/mja2.52237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/03/2023] [Indexed: 02/22/2024]
Affiliation(s)
- Luigi Zolio
- St Vincent's Hospital Melbourne, Melbourne, VIC
| | - Prudence A Francis
- St Vincent's Hospital Melbourne, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
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6
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Tang K, Ford B, Grasso SL, Swisher J. Infectious aortitis and managing it at a community military hospital. BMJ Case Rep 2024; 17:e257509. [PMID: 38538095 PMCID: PMC10982747 DOI: 10.1136/bcr-2023-257509] [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: 04/04/2024] Open
Abstract
Infectious aortitis is a rare disease process which can be of fungal, viral or bacterial aetiology. This disease process is often incidentally found during concomitant infectious processes, likely due to haematogenous spread. Common sources are from cardiac, genitourinary and gastroenterologic sources. CT imaging of the aorta is essential in identifying physiological changes-wall thickness changes, ectasia and stenosis. We present a case of a female in her early 60s with a medical history of cardiomyopathy with heart failure and reduced ejection fraction, who was initially admitted for acute cholecystitis complicated by the development of gallstone pancreatitis. Imaging evaluation incidentally noted findings consistent with aortitis with a penetrating ulcer, and blood cultures were positive for Staphylococcus aureus bacteraemia, confirming her diagnosis of infectious aortitis. She was started on intravenous antibiotics, required preoperative nutritional optimisation, and subsequently underwent an open aortic resection and aortoiliac reconstruction with rifampin-soaked Dacron graft.
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Affiliation(s)
- Kelly Tang
- General Surgery, William Beaumont Army Medical Center, El Paso, Texas, USA
| | - Brandon Ford
- General Surgery, William Beaumont Army Medical Center, El Paso, Texas, USA
| | - Samuel L Grasso
- General Surgery, William Beaumont Army Medical Center, El Paso, Texas, USA
| | - Jonathan Swisher
- General Surgery, William Beaumont Army Medical Center, El Paso, Texas, USA
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7
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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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Kermani TA, Byram K. Isolated Aortitis: Workup and Management. Rheum Dis Clin North Am 2023; 49:523-543. [PMID: 37331731 DOI: 10.1016/j.rdc.2023.03.013] [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: 06/20/2023]
Abstract
The finding of aortitis, often incidentally noted on surgical resection, should prompt evaluation for secondary causes including large-vessel vasculitis. In a large proportion of cases, no other inflammatory cause is identified and the diagnosis of clinically isolated aortitis is made. It is unknown whether this entity represents a more localized form of large-vessel vasculitis. The need for immunosuppressive therapy in patients with clinically isolated aortitis remains unclear. Patients with clinically isolated aortitis warrant imaging of the entire aorta at baseline and regular intervals because a significant proportion of patients have or develop abnormalities in other vascular beds.
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Affiliation(s)
- Tanaz A Kermani
- Division of Rheumatology, University of California Los Angeles, 2020 Santa Monica Boulevard, Suite 540, Santa Monica, CA 90404, USA.
| | - Kevin Byram
- Division of Rheumatology and Immunology, Vanderbilt University Medical Center, 1161 21st Avenue South, T3113, MCN, Nashville, TN 37232, USA
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9
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Perugino CA, Isselbacher EM, Baliyan V, Unizony SH, Smith RN. Case 18-2023: A 19-Year-Old Woman with Dyspnea and Tachypnea. N Engl J Med 2023; 388:2275-2286. [PMID: 37314709 DOI: 10.1056/nejmcpc2300894] [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: 06/15/2023]
Affiliation(s)
- Cory A Perugino
- From the Departments of Medicine (C.A.P., E.M.I., S.H.U.), Radiology (V.B.), and Pathology (R.N.S.), Massachusetts General Hospital, and the Departments of Medicine (C.A.P., E.M.I., S.H.U.), Radiology (V.B.), and Pathology (R.N.S.), Harvard Medical School - both in Boston
| | - Eric M Isselbacher
- From the Departments of Medicine (C.A.P., E.M.I., S.H.U.), Radiology (V.B.), and Pathology (R.N.S.), Massachusetts General Hospital, and the Departments of Medicine (C.A.P., E.M.I., S.H.U.), Radiology (V.B.), and Pathology (R.N.S.), Harvard Medical School - both in Boston
| | - Vinit Baliyan
- From the Departments of Medicine (C.A.P., E.M.I., S.H.U.), Radiology (V.B.), and Pathology (R.N.S.), Massachusetts General Hospital, and the Departments of Medicine (C.A.P., E.M.I., S.H.U.), Radiology (V.B.), and Pathology (R.N.S.), Harvard Medical School - both in Boston
| | - Sebastian H Unizony
- From the Departments of Medicine (C.A.P., E.M.I., S.H.U.), Radiology (V.B.), and Pathology (R.N.S.), Massachusetts General Hospital, and the Departments of Medicine (C.A.P., E.M.I., S.H.U.), Radiology (V.B.), and Pathology (R.N.S.), Harvard Medical School - both in Boston
| | - Rex N Smith
- From the Departments of Medicine (C.A.P., E.M.I., S.H.U.), Radiology (V.B.), and Pathology (R.N.S.), Massachusetts General Hospital, and the Departments of Medicine (C.A.P., E.M.I., S.H.U.), Radiology (V.B.), and Pathology (R.N.S.), Harvard Medical School - both in Boston
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10
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Duff LM, Scarsbrook AF, Ravikumar N, Frood R, van Praagh GD, Mackie SL, Bailey MA, Tarkin JM, Mason JC, van der Geest KSM, Slart RHJA, Morgan AW, Tsoumpas C. An Automated Method for Artifical Intelligence Assisted Diagnosis of Active Aortitis Using Radiomic Analysis of FDG PET-CT Images. Biomolecules 2023; 13:343. [PMID: 36830712 PMCID: PMC9953018 DOI: 10.3390/biom13020343] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/12/2023] Open
Abstract
The aim of this study was to develop and validate an automated pipeline that could assist the diagnosis of active aortitis using radiomic imaging biomarkers derived from [18F]-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography (FDG PET-CT) images. The aorta was automatically segmented by convolutional neural network (CNN) on FDG PET-CT of aortitis and control patients. The FDG PET-CT dataset was split into training (43 aortitis:21 control), test (12 aortitis:5 control) and validation (24 aortitis:14 control) cohorts. Radiomic features (RF), including SUV metrics, were extracted from the segmented data and harmonized. Three radiomic fingerprints were constructed: A-RFs with high diagnostic utility removing highly correlated RFs; B used principal component analysis (PCA); C-Random Forest intrinsic feature selection. The diagnostic utility was evaluated with accuracy and area under the receiver operating characteristic curve (AUC). Several RFs and Fingerprints had high AUC values (AUC > 0.8), confirmed by balanced accuracy, across training, test and external validation datasets. Good diagnostic performance achieved across several multi-centre datasets suggests that a radiomic pipeline can be generalizable. These findings could be used to build an automated clinical decision tool to facilitate objective and standardized assessment regardless of observer experience.
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Affiliation(s)
- Lisa M. Duff
- School of Medicine, University of Leeds, Leeds LS2 9JT, UK
- Institute of Medical and Biological Engineering, University of Leeds, Leeds LS2 9JT, UK
| | - Andrew F. Scarsbrook
- School of Medicine, University of Leeds, Leeds LS2 9JT, UK
- Department of Radiology, St. James University Hospital, Leeds LS9 7TF, UK
| | - Nishant Ravikumar
- School of Medicine, University of Leeds, Leeds LS2 9JT, UK
- Center for Computational Imaging and Simulation Technologies in Biomedicine, University of Leeds, Leeds LS2 9JT, UK
| | - Russell Frood
- School of Medicine, University of Leeds, Leeds LS2 9JT, UK
- Department of Radiology, St. James University Hospital, Leeds LS9 7TF, UK
| | - Gijs D. van Praagh
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Sarah L. Mackie
- School of Medicine, University of Leeds, Leeds LS2 9JT, UK
- NIHR Leeds Biomedical Research Centre and NIHR Leeds MedTech and In Vitro Diagnostics Co-Operative, Leeds Teaching Hospitals NHS Trust, Leeds LS7 4SA, UK
| | - Marc A. Bailey
- School of Medicine, University of Leeds, Leeds LS2 9JT, UK
- The Leeds Vascular Institute, Leeds General Infirmary, Leeds LS2 9NS, UK
| | - Jason M. Tarkin
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Justin C. Mason
- National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK
| | - Kornelis S. M. van der Geest
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Riemer H. J. A. Slart
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
- Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, 7522 NB Enschede, The Netherlands
| | - Ann W. Morgan
- School of Medicine, University of Leeds, Leeds LS2 9JT, UK
- NIHR Leeds Biomedical Research Centre and NIHR Leeds MedTech and In Vitro Diagnostics Co-Operative, Leeds Teaching Hospitals NHS Trust, Leeds LS7 4SA, UK
| | - Charalampos Tsoumpas
- School of Medicine, University of Leeds, Leeds LS2 9JT, UK
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
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Huang CH, Sim SS, Lien WC. Cardiac arrest caused by ruptured nonaneurysmal infectious aortitis. CAN J EMERG MED 2023; 25:90-92. [PMID: 36260217 DOI: 10.1007/s43678-022-00401-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 10/12/2022] [Indexed: 01/19/2023]
Affiliation(s)
- Chun-Hsiang Huang
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, Taiwan
| | - Shyh-Shyong Sim
- Department of Emergency Medicine, Far-Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, Taiwan.
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
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12
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Xu J, Bettendorf B, D'Oria M, Sharafuddin MJ. Multidisciplinary diagnosis and management of inflammatory aortic aneurysms. J Vasc Surg 2022:S0741-5214(22)02645-3. [PMID: 36565773 DOI: 10.1016/j.jvs.2022.12.024] [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: 03/05/2022] [Revised: 12/07/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Inflammatory abdominal aortic aneurysms (IAAAs) are a variant involving a distinct immunoinflammatory process, with nearly one half believed to be associated with IgG4-related disease (IgG4-RD). METHODS MEDLINE and Google Scholar searches were conducted for English-language publications relevant to inflammatory aortic aneurysms from January 1970 onward. The search terms included inflammatory aortic aneurysms, aortitis, periaortitis, IgG4-related disease, and retroperitoneal fibrosis. Relevant studies were selected for review based on their relevance. RESULTS Morphologically, IAAAs are characterized by a thickened aneurysm wall often displaying contrast enhancement and elevated metabolic activity on fluorine-18 fluorodeoxyglucose-positron emission tomography imaging. A strong association exists with perianeurysmal and retroperitoneal fibrosis. Although the rupture risk appears lower with IAAAs than with noninflammatory abdominal aortic aneurysms (AAAs), the currently recommended diameter threshold for operative management is the same. Open repair has been associated with increased morbidity compared with noninflammatory AAAs, and a retroperitoneal approach or minimal dissection transperitoneal approach has been recommended to avoid duodenal and retroperitoneal structural injuries. Endovascular aneurysm repair has been increasingly used, especially for patients unfit for open surgery. It is important to exclude an infectious etiology before the initiation of immunosuppressive therapy or operative repair. Multimodality imaging follow-up is critical to monitor disease activity and secondary involvement of retroperitoneal structures by the associated fibrotic process. Maintenance of immunosuppressive therapy will be needed postoperatively for most patients with active systemic disease, especially those with IgG4-RD and those with persistent symptoms. Additional interventions aimed at ureteral decompression could also be required, and lifelong follow-up is mandatory. CONCLUSIONS Preoperative multimodality imaging is a diagnostic cornerstone for assessment of the disease extent and activity. IgG4-RD is an increasingly recognized category of IAAAs, with implications for tailoring adjunctive medical therapy. Open surgical repair remains the procedure of choice, although endovascular aneurysm repair is increasingly being offered. Maintenance immunosuppressive therapy can be offered according to the disease activity as assessed by follow-up imaging studies.
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Affiliation(s)
- Jun Xu
- Division of Vascular Surgery, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Brittany Bettendorf
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste, Trieste, Italy
| | - Mel J Sharafuddin
- Division of Vascular Surgery, University of Iowa Carver College of Medicine, Iowa City, IA.
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Computed tomography for aortic assessment in children. Pediatr Radiol 2022; 52:2470-2484. [PMID: 36151220 DOI: 10.1007/s00247-022-05501-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/19/2022] [Accepted: 08/29/2022] [Indexed: 10/14/2022]
Abstract
Because the aorta is the major vessel of the body, basic knowledge of aortic pathology is essential to the pediatric imager. This review divides aortic pathology into anatomical (e.g., congenital abnormalities) and acquired (e.g., vasculitis, trauma) entities, providing a brief description of pathology, technical considerations in CT acquisition and processing, and some pearls and pitfalls of interpretation. The objective of this paper is to familiarize general pediatric imagers with imaging features of common as well as high-impact aortic pathology on CT and prepare them for acquisition and reporting.
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14
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Cobas-Paz R, Rioboo-Lestón L, Piñón-Esteban M, Calvo-Iglesias FE. The forgotten and silent enemy of the cardiovascular system: A rare case of aortitis. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:147-149. [PMID: 34955436 DOI: 10.1016/j.eimce.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/31/2021] [Accepted: 04/07/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Rafael Cobas-Paz
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Spain.
| | - Lucía Rioboo-Lestón
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Spain
| | - Miguel Piñón-Esteban
- Servicio de Cirugía Cardíaca, Hospital Universitario Álvaro Cunqueiro, Vigo, Spain
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15
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Arbustini E, Narula N. Aortic Smooth Muscle Detraining in Continuous Flow LVAD: Out of Practice. J Am Coll Cardiol 2021; 78:1796-1799. [PMID: 34711338 DOI: 10.1016/j.jacc.2021.08.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Eloisa Arbustini
- Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Department of Medical Sciences and Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Navneet Narula
- Department of Pathology, New York University Langone Health, New York, New York, USA
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Cobas-Paz R, Rioboo-Lestón L, Piñón-Esteban M, Calvo-Iglesias FE. The forgotten and silent enemy of the cardiovascular system: a rare case of aortitis. Enferm Infecc Microbiol Clin 2021; 40:S0213-005X(21)00085-9. [PMID: 33994247 DOI: 10.1016/j.eimc.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/31/2021] [Accepted: 04/07/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Rafael Cobas-Paz
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, España.
| | - Lucía Rioboo-Lestón
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, España
| | - Miguel Piñón-Esteban
- Servicio de Cirugía Cardiaca, Hospital Universitario Álvaro Cunqueiro, Vigo, España
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