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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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Pucci A, Rossetti M, Lenzi C, Buja ML. The cardiovascular pathologist in the aortic team. Cardiovasc Pathol 2024; 72:107649. [PMID: 38703970 DOI: 10.1016/j.carpath.2024.107649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 04/14/2024] [Accepted: 04/19/2024] [Indexed: 05/06/2024] Open
Abstract
Aortic diseases require a multidisciplinary management for diagnosis, treatment and follow-up with better outcomes in referral centers using a team-based approach. The setting up of a multi-disciplinary aortic team for the discussion of complex cases has been already proposed; it is also supported by the ACC/AHA. Surgeons and radiologists, more or less other physicians such as cardiologists, geneticists, rheumatologists/internal medicine specialists and pathologists are involved into such a team. The role of the cardiovascular pathologist is to examine the aortic specimens, to diagnose and classify the aortic lesions. Herein, the role of the pathologist in the aortic team is discussed and the pathobiology of aortic diseases is reviewed for reference by pathologists. The aortic specimens are mainly obtained from emergency or elective surgical procedures on the thoracic aorta, less frequently from organ/tissue (including cardiac or heart valve) donors, post-mortem procedures or abdominal aortic surgery. In the last decade, together with the progress of medical sciences, the histological definitions and classifications of the aortic pathology are undergoing thorough revisions that are addressed to an etiopathogenetic approach because of possible clinico-pathological correlations, therapeutic and prognostic impact. Pathologists may also have an important role in research and teaching. Therefore, histological analyses of the aortic specimens require adequate sample processing and pathologist expertise because histology contributes to definite diagnosis, correct management of patients and even (in genetic diseases) families, but also to research in the challenging field of aortopathies.
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Affiliation(s)
- Angela Pucci
- Department of Histopathology, Pisa University Hospital, Pisa, Italy.
| | - Martina Rossetti
- Department of Histopathology, Pisa University Hospital, Pisa, Italy
| | - Chiara Lenzi
- Department of Histopathology, Pisa University Hospital, Pisa, Italy
| | - Maximilian L Buja
- Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
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3
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Ahmed H, Ismayl M, Palicherla A, Mathew Kalathil RA, Vaza S, Kabach A, Goldsweig AM, Aboeata A. A rare case of aortitis presenting as chest pain: a case report and literature review. Ann Med Surg (Lond) 2024; 86:4165-4169. [PMID: 38989168 PMCID: PMC11230809 DOI: 10.1097/ms9.0000000000002140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 04/25/2024] [Indexed: 07/12/2024] Open
Abstract
Introduction and importance Chest pain is a frequent reason patients seek medical attention. The broad spectrum of potential etiologies makes determining the underlying cause of chest pain complex. Among cardiovascular etiologies, aortitis is a rare but life-threatening possibility that should be considered in the differential diagnosis. Case presentation A 53-year-old female with a history of smoking presented with progressively worsening chest and epigastric pain over several weeks. She had seen multiple physicians previously for the same symptoms with unremarkable work-ups. Physical examination was notable for severe tenderness upon palpation of her lower abdomen. The electrocardiogram and troponins were unremarkable. Computed tomography of the abdomen revealed aneurysmal dilatation of the abdominal aorta, soft tissue thickening, and surrounding inflammatory stranding, consistent with aortitis. Infectious and autoimmune work-ups were unremarkable. Intravenous steroids were initiated, and her symptoms improved significantly. Her aortitis was attributed to inflammation secondary to chronic smoking. Clinical discussion Aortitis is a rare condition with varied clinical presentations. Etiologies of aortitis include infection and non-infectious inflammation. Diagnosis of aortitis requires a thorough clinical assessment and prompt imaging of the aorta, with computed tomography being the preferred imaging modality. Conclusion Evaluation for cardiovascular chest pain must extend beyond an electrocardiogram and troponin level. Imaging should be considered in patients with atypical symptoms. Aortitis is a rare but important diagnosis requiring immediate treatment.
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Affiliation(s)
- Hasaan Ahmed
- Department of Medicine, Division of Internal Medicine, Creighton University School of Medicine, Omaha, NE
| | - Mahmoud Ismayl
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Anirudh Palicherla
- Department of Medicine, Division of Internal Medicine, Creighton University School of Medicine, Omaha, NE
| | - Ruth Ann Mathew Kalathil
- Department of Medicine, Division of Internal Medicine, Creighton University School of Medicine, Omaha, NE
| | - Shivani Vaza
- Department of Medicine, Division of Internal Medicine, Creighton University School of Medicine, Omaha, NE
| | - Amjad Kabach
- Department of Medicine, Division of Cardiovascular Disease, Creighton University School of Medicine, Omaha, NE
| | - Andrew M. Goldsweig
- Department of Cardiovascular Medicine, Baystate Medical Center, Springfield, MA, USA
| | - Ahmed Aboeata
- Department of Medicine, Division of Cardiovascular Disease, Creighton University School of Medicine, Omaha, NE
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4
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Takla A, Eid F, Eid MM, Joshi A, Abtahian F, Cheng A, Feitell S. Anterior STEMI in a 25-year-old with Cogan syndrome. J Cardiol Cases 2024; 30:9-11. [PMID: 39007044 PMCID: PMC11245749 DOI: 10.1016/j.jccase.2024.02.014] [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: 12/24/2023] [Revised: 02/21/2024] [Accepted: 02/25/2024] [Indexed: 07/16/2024] Open
Abstract
Cogan syndrome (CS) is a chronic inflammatory disorder primarily affecting young adults. It is characterized by interstitial keratitis, vestibuloauditory dysfunction, and, rarely, systemic vasculitis and aortitis. In this case report, we present a rare instance of a young male with anterior ST-elevation myocardial infarction in the context of aneurysmal coronary vessels and proximal occlusion of the left anterior descending artery. This case underscores the importance of recognizing cardiac risk factors in the setting of CS, as they can be life-threatening. Regular follow up is necessary, especially for patients showing signs of vasculitis or experiencing cardiac symptoms. A multidisciplinary approach to management can help optimize the prognosis for these complex patients. Learning objective Comprehend Cogan syndrome (CS): Grasp the clinical manifestations and potential cardiovascular complications of CS. Diagnostic approach in CS: Differentiate cardiac symptoms in CS from typical coronary diseases, emphasizing the role of heart catheterization. Multidisciplinary management: Recognize the importance of integrating rheumatologists, cardiologists, and surgeons for optimal CS patient outcomes.
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Affiliation(s)
- Andrew Takla
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Fahad Eid
- Department of Internal Medicine, Unity Hospital, Rochester, NY, USA
| | - Mohamed Magdi Eid
- Department of Cardiovascular Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Akshay Joshi
- Department of Cardiovascular Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Farhad Abtahian
- Department of Cardiovascular Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Allen Cheng
- Department of Cardiothoracic Surgery, Rochester General Hospital, Rochester, NY, USA
| | - Scott Feitell
- Department of Cardiovascular Medicine, Rochester General Hospital, Rochester, NY, USA
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Skov RAC, Lawaetz M, Eldrup N, Resch TA, Sörelius K. Danish Nationwide Study on Surgical Treatment of Infective Native Abdominal Aortic Aneurysms. Eur J Vasc Endovasc Surg 2024; 68:110-118. [PMID: 37944790 DOI: 10.1016/j.ejvs.2023.11.006] [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: 06/08/2023] [Revised: 10/03/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE This study aimed to describe surgical trends, survival, and infection related complications (IRC) in a Danish cohort of patients with infective native aortic aneurysms (INAAs). METHODS A retrospective nationwide cohort study including all patients in Denmark who were surgically treated for abdominal INAA between 2000 and 2020 was conducted. Patients were identified through the Danish vascular registry, Karbase, which is a database registering all patients treated with vascular surgery in Denmark. Subsequent data on clinical presentation, treatment, all cause mortality, and complications were obtained from the electronic patient charts. RESULTS Seventy-five patients were included in the study, of whom 60 (80%) were male, with a median age of 69 (IQR 64, 75) years. Open surgical repair (OSR) was performed in 54 (72%) patients and endovascular aortic repair (EVAR) in 21 (28%). Median follow up was 52 (IQR 32, 103) months. Open repair was consistently the most frequent treatment modality throughout the study period, but EVAR became more frequent over time. The 30 day survival of the total cohort was 97% (94 - 100%). Kaplan-Meier survival estimates for the cohort were 92% (95% CI 85 - 98%), 80% (95% CI 71 - 91%), 63% (95% CI 52 - 78%), and 48% (95% CI 35 - 66%) at one, three, five and 10 years, respectively. Patients treated by EVAR had comparable long term survival to patients treated by OSR, with a hazard ratio of 0.35 (95% CI 0.10 - 1.22), but was associated with better short term survival up to five years. The most common cause of death was sepsis. Five (9%) OSR patients had IRC compared with one (5%) EVAR patient. CONCLUSION In this nationwide study of patients treated for abdominal INAA, an increasing number of patients were surgically treated during the study period. Patients treated by EVAR demonstrated long term survival comparable to OSR. The incidence of post-operative IRC was low. These results should be interpreted with caution and prospective registries are needed.
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Affiliation(s)
- Rebecca A C Skov
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Denmark.
| | - Martin Lawaetz
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; Nordic Health Group, Copenhagen, Denmark
| | - Nikolaj Eldrup
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Timothy A Resch
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Karl Sörelius
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Raizada A, Trivedi D. Isolated Idiopathic Aortitis in a Young Female Presenting With Exertional Chest Pain: A Case Report. Cureus 2024; 16:e63415. [PMID: 39077254 PMCID: PMC11284509 DOI: 10.7759/cureus.63415] [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] [Accepted: 06/28/2024] [Indexed: 07/31/2024] Open
Abstract
Aortitis is a general term that describes inflammation of the aorta. In most cases, this inflammation is caused by an autoimmune etiology or an infectious etiology. In some instances, the underlying etiology may not be clear, and the diagnosis given is idiopathic aortitis. Cases of idiopathic aortitis are usually diagnosed based on histopathologic findings. Here, we present a case involving a 31-year-old female presenting with acutely worsening exertional shortness of breath and left-sided chest pain. An echocardiogram revealed a severely reduced ejection fraction with severe aortic regurgitation and diffusely increased aortic intima-media thickness. Bioprosthetic aortic valve replacement was performed with histology, showing findings consistent with aortitis, and the patient received the diagnosis of idiopathic aortitis. This case highlights the need to consider aortitis as a differential in young patients presenting with exertional chest pain and severe aortic insufficiency.
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Affiliation(s)
- Amit Raizada
- Internal Medicine, New York Presbyterian Brooklyn Methodist Hospital, New York City, USA
| | - Dhaval Trivedi
- Internal Medicine, New York Presbyterian Brooklyn Methodist Hospital, New York City, USA
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Kunow A, Freyer Martins Pereira J, Chenot JF. Extravertebral low back pain: a scoping review. BMC Musculoskelet Disord 2024; 25:363. [PMID: 38714994 PMCID: PMC11075250 DOI: 10.1186/s12891-024-07435-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 04/11/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Low back pain (LBP) is one of the most common reasons for consultation in general practice. Currently, LBP is categorised into specific and non-specific causes. However, extravertebral causes, such as abdominal aortic aneurysm or pancreatitis, are not being considered. METHODS A systematic literature search was performed across MEDLINE, Embase, and the Cochrane library, complemented by a handsearch. Studies conducted between 1 January 2001 and 31 December 2020, where LBP was the main symptom, were included. RESULTS The literature search identified 6040 studies, from which duplicates were removed, leaving 4105 studies for title and abstract screening. Subsequently, 265 publications were selected for inclusion, with an additional 197 publications identified through the handsearch. The majority of the studies were case reports and case series, predominantly originating from specialised care settings. A clear distinction between vertebral or rare causes of LBP was not always possible. A range of diseases were identified as potential extravertebral causes of LBP, encompassing gynaecological, urological, vascular, systemic, and gastrointestinal diseases. Notably, guidelines exhibited inconsistencies in addressing extravertebral causes. DISCUSSION Prior to this review, there has been no systematic investigation into extravertebral causes of LBP. Although these causes are rare, the absence of robust and reliable epidemiological data hinders a comprehensive understanding, as well as the lack of standardised protocols, which contributes to a lack of accurate description of indicative symptoms. While there are certain disease-specific characteristics, such as non-mechanical or cyclical LBP, and atypical accompanying symptoms like fever, abdominal pain, or leg swelling, that may suggest extravertebral causes, it is important to recognise that these features are not universally present in every patient. CONCLUSION The differential diagnosis of extravertebral LBP is extensive with relatively low prevalence rates dependent on the clinical setting. Clinicians should maintain a high index of suspicion for extravertebral aetiologies, especially in patients presenting with atypical accompanying symptoms.
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Affiliation(s)
- Anna Kunow
- Department of General Practice, University Medicine Greifswald, 17475, Fleischmannstraße, Greifswald, Germany.
| | | | - Jean-François Chenot
- Department of General Practice, University Medicine Greifswald, 17475, Fleischmannstraße, Greifswald, Germany
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8
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Gola C, Fingerhood S, Parry NM, Diaz-Delgado J. Dissecting aortitis in a goat associated with Pasteurella multocida and Staphylococcus spp infection. J Comp Pathol 2024; 211:17-20. [PMID: 38759507 DOI: 10.1016/j.jcpa.2024.04.002] [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: 02/03/2024] [Revised: 04/02/2024] [Accepted: 04/18/2024] [Indexed: 05/19/2024]
Abstract
Reports of primary cardiovascular disease in goats are rare and most commonly include ventricular septal defect, valvular endocarditis, traumatic pericarditis, ionophore poisoning and nutritional cardiomyopathies. We now report the pathological findings in a 67 kg, 6-year-old, adult female Boer goat that presented with neurological signs (ie, head pressing, unsteadiness and paddling) and hyperthermia 2 days prior to death. Lack of therapeutic response to meloxicam and penicillin‒streptomycin and poor prognosis led to euthanasia of the animal. At necropsy, the main findings included severe aortic dissection with luminal thrombosis and stenosis, and pulmonary congestion and oedema. Histological examination of the aorta revealed severe chronic granulomatous and fibrosing dissecting aortitis with mineralization. Bacterial culture of the affected aortic segment resulted in isolation of a profuse growth of Pasteurella multocida and a moderate growth of Staphylococcus spp. Histopathological findings in the central nervous system were consistent with neurolisteriosis.
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Affiliation(s)
- Cecilia Gola
- Veterinary Pathology Centre, University of Surrey, Francis Crick Road, Guildford, GU27AQ, Surrey, UK
| | - Sai Fingerhood
- Veterinary Pathology Centre, University of Surrey, Francis Crick Road, Guildford, GU27AQ, Surrey, UK.
| | - Nicola M Parry
- CBSET Inc., 500 Shire Way, Lexington, Massachussetts, 02421, USA
| | - Josué Diaz-Delgado
- Texas A&M Veterinary Medical Diagnostic Laboratory, 483 Agronomy Road, College Station, Texas, 77843, USA
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9
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Applefeld WN, Jentzer JC. Initial Triage and Management of Patients with Acute Aortic Syndromes. Cardiol Clin 2024; 42:195-213. [PMID: 38631790 DOI: 10.1016/j.ccl.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
The acute aortic syndromes (AAS) are life-threatening vascular compromises within the aortic wall. These include aortic dissection (AD), intramural hematoma (IMH), penetrating aortic ulcer (PAU), and blunt traumatic thoracic aortic injury (BTTAI). While patients classically present with chest pain, the presentation may be highly variable. Timely diagnosis is critical to initiate definitive treatment and maximize chances of survival. In high-risk patients, treatment should begin immediately, even while diagnostic evaluation proceeds. The mainstay of medical therapy is acute reduction of heart rate and blood pressure. Surgical intervention is often required but is informed by patient anatomy and extent of vascular compromise.
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Affiliation(s)
- Willard N Applefeld
- Division of Cardiology, Department of Internal Medicine, Duke University School of Medicine, 2301 Erwin Road, Durham, NC 27710, USA
| | - Jacob C Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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10
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Younger DS. Headaches and Vasculitis. Neurol Clin 2024; 42:389-432. [PMID: 38575258 DOI: 10.1016/j.ncl.2023.12.003] [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: 04/06/2024]
Abstract
Vasculitis refers to heterogeneous clinicopathologic disorders that share the histopathology of inflammation of blood vessels. Unrecognized and therefore untreated, vasculitis of the nervous system leads to pervasive injury and disability making this a disorder of paramount importance to all clinicians. Headache may be an important clue to vasculitic involvement of central nervous system (CNS) vessels. CNS vasculitis may be primary, in which only intracranial vessels are involved in the inflammatory process, or secondary to another known disorder with overlapping systemic involvement. Primary neurologic vasculitides can be diagnosed with assurance after intensive evaluation that incudes tissue confirmation whenever possible.
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Affiliation(s)
- David S Younger
- Department of Medicine, Section of Neuroscience, City University of New York School of Medicine, New York, NY, USA; Department of Neurology, White Plains Hospital, White Plains, NY, USA.
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Xu S, Jiemy WF, Boots AMH, Arends S, van Sleen Y, Nienhuis PH, van der Geest KSM, Heeringa P, Brouwer E, Sandovici M. Altered Plasma Levels and Tissue Expression of Fibroblast Activation Protein Alpha in Giant Cell Arteritis. Arthritis Care Res (Hoboken) 2024. [PMID: 38685696 DOI: 10.1002/acr.25354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 04/09/2024] [Accepted: 04/26/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE Giant cell arteritis (GCA) is characterized by granulomatous inflammation of the medium- and large-sized arteries accompanied by remodeling of the vessel wall. Fibroblast activation protein alpha (FAP) is a serine protease that promotes both inflammation and fibrosis. Here, we investigated the plasma levels and vascular expression of FAP in GCA. METHODS Plasma FAP levels were measured with enzyme-linked immunosorbent assay in treatment-naive patients with GCA (n = 60) and polymyalgia rheumatica (PMR) (n = 63) compared with age- and sex-matched healthy controls (HCs) (n = 42) and during follow-up, including treatment-free remission (TFR). Inflamed temporal artery biopsies (TABs) of patients with GCA (n = 9), noninflamed TABs (n = 14), and aorta samples from GCA-related (n = 9) and atherosclerosis-related aneurysm (n = 11) were stained for FAP using immunohistochemistry. Immunofluorescence staining was performed for fibroblasts (CD90), macrophages (CD68/CD206/folate receptor beta), vascular smooth muscle cells (desmin), myofibroblasts (α-smooth muscle actin), interleukin-6 (IL-6), and matrix metalloproteinase-9 (MMP-9). RESULTS Baseline plasma FAP levels were significantly lower in patients with GCA compared with patients with PMR and HCs and inversely correlated with systemic markers of inflammation and angiogenesis. FAP levels decreased even further at 3 months on remission in patients with GCA and gradually increased to the level of HCs in TFR. FAP expression was increased in inflamed TABs and aorta of patients with GCA compared with control tissues. FAP was abundantly expressed in fibroblasts and macrophages. Some of the FAP+ fibroblasts expressed IL-6 and MMP-9. CONCLUSION FAP expression in GCA is clearly modulated both in plasma and in vessels. FAP may be involved in the inflammatory and remodeling processes in GCA and have utility as a target for imaging and therapeutic intervention.
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Affiliation(s)
- Shuang Xu
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - William F Jiemy
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Annemieke M H Boots
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Suzanne Arends
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Yannick van Sleen
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Pieter H Nienhuis
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Kornelis S M van der Geest
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Peter Heeringa
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Elisabeth Brouwer
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Maria Sandovici
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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De Gaspari M, Ascione A, Baldovini C, Marzullo A, Pucci A, Rizzo S, Salzillo C, Angelini A, Basso C, d’Amati G, di Gioia CRT, van der Wal AC, Giordano C. Cardiovascular pathology in vasculitis. Pathologica 2024; 116:78-92. [PMID: 38767541 PMCID: PMC11138763 DOI: 10.32074/1591-951x-993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 05/22/2024] Open
Abstract
Vasculitides are diseases that can affect any vessel. When cardiac or aortic involvement is present, the prognosis can worsen significantly. Pathological assessment often plays a key role in reaching a definite diagnosis of cardiac or aortic vasculitis, particularly when the clinical evidence of a systemic inflammatory disease is missing. The following review will focus on the main histopathological findings of cardiac and aortic vasculitides.
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Affiliation(s)
- Monica De Gaspari
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Azienda Ospedaliera, Padova, Italy
| | - Andrea Ascione
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Chiara Baldovini
- Department of Pathology, Cardiovascular and Cardiac Transplant Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Marzullo
- Department of Precision and Regenerative Medicine and Ionian Area, Pathology Unit, University of Bari “Aldo Moro”, Bari, Italy
| | - Angela Pucci
- Histopathology Department, University Hospital of Pisa, Pisa, Italy
| | - Stefania Rizzo
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Azienda Ospedaliera, Padova, Italy
| | - Cecilia Salzillo
- Department of Precision and Regenerative Medicine and Ionian Area, Pathology Unit, University of Bari “Aldo Moro”, Bari, Italy
| | - Annalisa Angelini
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Azienda Ospedaliera, Padova, Italy
| | - Cristina Basso
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Azienda Ospedaliera, Padova, Italy
| | - Giulia d’Amati
- Department of Radiology, Oncology and Pathology, Sapienza University, Rome, Italy
| | | | - Allard C. van der Wal
- Department of Pathology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Carla Giordano
- Department of Radiology, Oncology and Pathology, Sapienza University, Rome, Italy
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13
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Ohno Y, Ueki Y, Oshima S, Omata J, Yokoyama Y, Takahashi T, Shodo R, Yamazaki K, Horii A. Aortic rupture following acute aortitis in a patient with head and neck carcinoma treated with nivolumab: a rare but severe immune-related adverse event. Eur Arch Otorhinolaryngol 2024; 281:2037-2040. [PMID: 38308762 DOI: 10.1007/s00405-024-08495-2] [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: 11/03/2023] [Accepted: 01/22/2024] [Indexed: 02/05/2024]
Abstract
INTRODUCTION Immune-related adverse events (irAEs) due to immune checkpoint inhibitors may lead to discontinuation and treatment-related death. Acute aortitis is a rare but severe irAE. CASE PRESENTATION A 67-year-old man with recurrent lower gingival carcinoma received nivolumab therapy. Twenty-three months later, he experienced chest compression, which resulted in syncope. Following a whole-body computed tomography (CT) scanning, which revealed diffuse thickening of the aorta, and systemic assessments of the causes of aortitis, he was diagnosed with acute aortitis due to irAE. Nivolumab discontinuation and oral steroids improved CT findings. However, 11 months after nivolumab discontinuation, he developed an aortic aneurysmal rupture. Endovascular aortic repair rescued him. A durable anti-cancer response was still observed 4 months after the aortic rupture. CONCLUSION Although severe irAE, such as acute aortitis, occurred, the patient may still achieve a durable response. A broad examination and prompt treatment of irAE can help improve the patient's survival.
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Affiliation(s)
- Yuki Ohno
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 950-8510, Japan
| | - Yushi Ueki
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 950-8510, Japan.
| | - Shusuke Oshima
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 950-8510, Japan
| | - Jo Omata
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 950-8510, Japan
| | - Yusuke Yokoyama
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 950-8510, Japan
| | - Takeshi Takahashi
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 950-8510, Japan
| | - Ryusuke Shodo
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 950-8510, Japan
| | - Keisuke Yamazaki
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 950-8510, Japan
| | - Arata Horii
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 950-8510, Japan
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Brauner JF, Rasul S, Berzaczy D, Beitzke D, Wollenweber T, Beitzke D. Hybrid PET/MRI of large vessel vasculitis : Radiation dose compared to PET/CT with view on cumulative effective dose. Wien Klin Wochenschr 2024:10.1007/s00508-024-02336-2. [PMID: 38456940 DOI: 10.1007/s00508-024-02336-2] [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: 09/26/2023] [Accepted: 02/09/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND The diagnosis of large vessel vasculitis (LVV) is often challenging due to the various clinical appearances and the low prevalence. Hybrid imaging by positron emission tomography and computed tomography (PET/CT) is a highly relevant imaging modality for diagnostics and disease surveillance but may be associated with a significant amount of radiation dose especially in patients with complications. OBJECTIVE The aim of this retrospective analysis was to compare the image quality and impact of hybrid imaging methods PET/CT and PET/MRI on the potential for dose reduction. METHODS This retrospective single-center study included a cohort of 32 patients who were referred to PET/MRI for the evaluation of LVV, including graft infections and fever of unknown origin. This cohort was compared to a similar cohort of 37 patients who were examined with PET/CT in the same period. Mean radiation dose as well as image quality to establish a diagnosis were compared between the groups. RESULTS The mean radiation dose applied in PET/MRI was significantly lower when compared to PET/CT (mean 6.6 mSV vs. 31.7 mSV; p < 0.001). This effect was based on the partially multiphasic CT protocols. At the same time, diagnostic image quality using a 4-point scale showed similar results for both imaging modalities in the work-up of LVV. CONCLUSION With PET/MRI, the radiation exposure can be significantly reduced with similar image quality and diagnostic impact. Patients with LVV have a higher risk of receiving a clinically relevant cumulative effective dose (CED) and PET/MRI should be made available to them.
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Affiliation(s)
- Johanna-Felicia Brauner
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Sazan Rasul
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Dominik Berzaczy
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Daniela Beitzke
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- University for Applied Science Wiener Neustadt, Johannes Gutenberg-Straße 3, 2700, Wiener Neustadt, Austria
| | - Tim Wollenweber
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Dietrich Beitzke
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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15
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Ito M, Amari M, Sato A, Hikichi M. Granulocyte-Colony Stimulating Factor (G-CSF)-Induced Aortitis: A Case Report. Cureus 2024; 16:e54845. [PMID: 38533155 PMCID: PMC10964047 DOI: 10.7759/cureus.54845] [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] [Accepted: 02/24/2024] [Indexed: 03/28/2024] Open
Abstract
Pegylated granulocyte colony-stimulating factor (G-CSF), commonly used in chemotherapy-induced neutropenia, has been associated with rare instances of aortitis. This study describes a 67-year-old female patient with estrogen receptor (ER)-positive, human epidermal growth factor receptor-2-positive breast cancer, undergoing chemotherapy with an epirubicin/cyclophosphamide (EC) regimen (epirubicin, cyclophosphamide) and pegylated G-CSF for neutropenia prophylaxis. Post-treatment, she developed symptoms including intermittent fever and severe arthralgia. Laboratory tests revealed an elevated white blood cell count, C-reactive protein levels, and erythrocyte sedimentation rate, while a computed tomography scan showed thickening in the aortic arch and descending aorta. Given the clinical presentation and exclusion of other potential causes, pegylated G-CSF-induced aortitis was suspected. The patient's symptoms improved significantly following the cessation of pegylated G-CSF, aiding in the differentiation from other types of aortitis. This study highlights the importance of considering pegylated G-CSF as a potential cause of aortitis in patients presenting with unexplained symptoms of fever and inflammation after chemotherapy. The rapid improvement upon discontinuation of the drug is a key feature distinguishing it from other aortitis causes. In conclusion, while rare, aortitis should be considered in the differential diagnosis of patients treated with pegylated G-CSF who exhibit relevant clinical symptoms. Early detection and management, including the discontinuation of the causative agent, are crucial for patient recovery and prognosis.
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Affiliation(s)
- Masahiro Ito
- Breast Surgery, Tohoku Kosai Hospital, Sendai, JPN
| | | | - Akiko Sato
- Breast Surgery, Tohoku Kosai Hospital, Sendai, JPN
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16
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Lone HU, Ashraf S, Carr CS, Bossom I, Alkhulaifi AM. Infected Takayasu's arteritis presenting with aortic perforation. JRSM Open 2024; 15:20542704231222735. [PMID: 38390225 PMCID: PMC10883127 DOI: 10.1177/20542704231222735] [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: 02/24/2024] Open
Abstract
We want to remind Physicians that unusual conditions can present in unusual ways and to keep an open mind always.
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Affiliation(s)
- Hafeez U Lone
- Department of Cardiothoracic Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Shady Ashraf
- Department of Cardiothoracic Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Cornelia S Carr
- Department of Cardiothoracic Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Issam Bossom
- Department of Pathology, Hamad Medical Corporation, Doha, Qatar
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17
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Benites-Yshpilco L, Barriales-Revilla L, Baltodano-Arellano R, Falcón-Quispe L, Cupe-Chacalcaje K, Cachicatari-Beltrán Á, Lévano-Pachas G. Multimodal imaging in Ig G4- related aortitis: case report. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2024; 5:50-53. [PMID: 38596609 PMCID: PMC10999319 DOI: 10.47487/apcyccv.v5i1.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 11/26/2023] [Indexed: 04/11/2024]
Abstract
We present the case of a 56-year-old patient with fever of unknown origin associated with chest and lumbar pain. Multimodality imaging revealed diffuse peri-aortitis in the thoracic aorta without involvement of the aortic valve, contributing substantially to the diagnosis of Ig G4-associated aortitis. Immunosuppressive therapy was started. Follow-up at five months with cardiac magnetic resonance imaging showed a reduction in the inflammatory process in the thoracic aorta.
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Affiliation(s)
- Lindsay Benites-Yshpilco
- Hospital Guillermo Almenara Irigoyen - EsSalud, Lima, Perú.Hospital Guillermo Almenara Irigoyen - EsSaludLimaPerú
| | - Lucia Barriales-Revilla
- Hospital Guillermo Almenara Irigoyen - EsSalud, Lima, Perú.Hospital Guillermo Almenara Irigoyen - EsSaludLimaPerú
| | - Roberto Baltodano-Arellano
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, PerúUniversidad Nacional Mayor de San MarcosFacultad de MedicinaUniversidad Nacional Mayor de San MarcosLimaPeru
- Cardiac imaging area of Cardiology Service, Hospital Guillermo Almenara Irigoyen - EsSalud, Lima, Perú.Cardiac imaging area of Cardiology ServiceHospital Guillermo Almenara Irigoyen - EsSaludLimaPerú
| | - Luis Falcón-Quispe
- Cardiac imaging area of Cardiology Service, Hospital Guillermo Almenara Irigoyen - EsSalud, Lima, Perú.Cardiac imaging area of Cardiology ServiceHospital Guillermo Almenara Irigoyen - EsSaludLimaPerú
| | - Kelly Cupe-Chacalcaje
- Cardiac imaging area of Cardiology Service, Hospital Guillermo Almenara Irigoyen - EsSalud, Lima, Perú.Cardiac imaging area of Cardiology ServiceHospital Guillermo Almenara Irigoyen - EsSaludLimaPerú
| | - Ángela Cachicatari-Beltrán
- Cardiac imaging area of Cardiology Service, Hospital Guillermo Almenara Irigoyen - EsSalud, Lima, Perú.Cardiac imaging area of Cardiology ServiceHospital Guillermo Almenara Irigoyen - EsSaludLimaPerú
| | - Gerald Lévano-Pachas
- Hospital Guillermo Almenara Irigoyen - EsSalud, Lima, Perú.Hospital Guillermo Almenara Irigoyen - EsSaludLimaPerú
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18
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Reddy P, Nair KS, Kumar V, Bowen JM, Deyle DR, Pochettino A, Connolly HM, Anavekar NS. Thoracic Aortic Aneurysmal Disease: Comprehensive Recommendations for the Primary Care Physician. Mayo Clin Proc 2024; 99:111-123. [PMID: 38176819 DOI: 10.1016/j.mayocp.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/17/2023] [Accepted: 07/12/2023] [Indexed: 01/06/2024]
Abstract
Thoracic aortic aneurysm (TAA) is a commonly encountered disease that is defined as aortic dilation with an increase in diameter of at least 50% greater than the expected age- and sex-adjusted size. Thoracic aortic aneurysms are described by their size, location, morphology, and cause. Primary care clinicians and other noncardiologists are often the first point of contact for patients with TAA. This review is intended to provide them with basic information on the differential diagnosis, diagnostic evaluation, and medical and surgical management of TAAs. Management decisions depend on having as precise a diagnosis as possible. Fortunately, this can often be achieved with a stepwise diagnostic approach that incorporates imaging and targeted genetic testing. Our review includes recommendations. In this review, we discuss these issues at a basic level and include recommendations for patients considering pregnancy.
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Affiliation(s)
- Prajwal Reddy
- Department of Cardiology, Mayo Clinic, Rochester, MN.
| | - Kaavya S Nair
- College of Osteopathic Medicine, Kansas City University, Kansas City, MO
| | - Vinayak Kumar
- Department of Cardiology, Mayo Clinic, Rochester, MN
| | - Juan M Bowen
- Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - David R Deyle
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN
| | | | | | - Nandan S Anavekar
- Department of Cardiology, Mayo Clinic, Rochester, MN; Department of Radiology, Mayo Clinic, Rochester, MN
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19
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Younger DS. Systemic vasculitis and headache. Curr Opin Neurol 2023; 36:631-646. [PMID: 37865837 PMCID: PMC10624412 DOI: 10.1097/wco.0000000000001223] [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: 10/23/2023]
Abstract
PURPOSE OF REVIEW Vasculitis refers to heterogeneous clinicopathologic disorders that share the histopathology of inflammation of blood vessels. Unrecognized and therefore untreated, vasculitis of the nervous system or so called neurovasculitides, lead to pervasive injury and disability making these disorder of paramount importance to clinicians. RECENT FINDINGS Headache is an important clue to vasculitic involvement of central nervous system (CNS) vessels. CNS vasculitis may be primary, in which only intracranial vessels are involved in the inflammatory process, or secondary to another known disorder with overlapping systemic involvement. A suspicion of vasculitis based on the history, clinical examination, or laboratory studies warrants prompt evaluation and treatment to forestall progression and avert cerebral ischemia or infarction. There has been remarkable progress in the pathogenesis, diagnosis, and treatment of primary adult and pediatric CNS vasculitides predicated on achievements in primary systemic forms. SUMMARY Vasculitis can be diagnosed with certainty after intensive evaluation that includes tissue confirmation whenever possible. Clinicians must choose from among the available immune modulating, suppressive, and targeted immunotherapies to induce and maintain remission status and prevent relapse, tempered by the recognition of anticipated medication side effects.
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Affiliation(s)
- David S Younger
- Department of Medicine, Section of Neuroscience, City University of New York School of Medicine, New York, NY; Department of Neurology, White Plains Hospital, White Plains, New York, USA
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20
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Zhao L, Zhou Y, Yu Q, Can Y, Ma B. The usefulness of ultrasound-guided coarse needle aspiration in carotid arteries for diagnosis of carotid arteritis: probing of the vascular margin. Quant Imaging Med Surg 2023; 13:8839-8845. [PMID: 38106239 PMCID: PMC10721988 DOI: 10.21037/qims-23-350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 09/11/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Ling Zhao
- Department of Ultrasound, Chinese People’s Liberation Army 63820 Hospital, Mianyang, China
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Yong Zhou
- Department of Ultrasound, The Third Hospital of Changsha, Changsha, China
| | - Qian Yu
- Department of Ultrasound, Leshan Hospital of Traditional Chinese Medicine, Leshan, China
| | - Yue Can
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Buyun Ma
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, China
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21
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He LM, Liu M, Dong WY, Sun XL. Takayasu arteritis and hyperthyroidism: A secondary hypertension case report. Medicine (Baltimore) 2023; 102:e35623. [PMID: 38013274 PMCID: PMC10681465 DOI: 10.1097/md.0000000000035623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/22/2023] [Indexed: 11/29/2023] Open
Abstract
INTRODUCTION Renovascular disease and hyperthyroidism are secondary hypertension. Takayasu arteritis (TAK) is a chronic, progressive, nonspecific great vasculitis involving the aorta and its major branches. It is one of the causes of renal artery stenosis. Hyperthyroidism is an endocrine disease caused by improper continuous synthesis and secretion of excessive thyroid hormone by the thyroid gland. Both diseases can raise blood pressure (BP). CASE PRESENTATION we present a case of 18-year-old. Female, after exercise, fatigue palpitations. The maximum BP was 190/87 mm Hg, ankle-brachial index was <0.9. C-reactive protein and erythrocyte sedimentation rate were elevated. Imaging revealed multiple vascular stenosis. Triiodothyronine, tetraiodothyroxine, serum-free triiodothyronine, serum-free thyroxine, thyroid peroxidase antibody and thyroid stimulating receptor antibody were elevated. TSH reduced. She was diagnosed with TAK and hyperthyroidism. After treatment, the BP was normal, the thyroid function gradually returned to normal, and the symptoms improved. CONCLUSION It is suggested that the BP of both upper limbs should be measured in newly diagnostic hypertension. If BP is not measured in both upper limbs, it is likely to be missed diagnosis. The cause of vascular stenosis needs to be identified, otherwise interventional treatment may lead to aggravation of the condition. Few cases of TAK complicated with hyperthyroidism have been reported. Both diseases are related to the immune system, whether there is any correlation between the 2 diseases, further research is needed. Early diagnosis, early treatment, the earlier intervention, the better prognosis.
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Affiliation(s)
- Lian-Man He
- Department of Hypertension, Henan Province People’s Hospital, Zheng Zhou, China
| | - Min Liu
- Department of Hypertension, Henan Province People’s Hospital, Zheng Zhou, China
| | - Wen-Yong Dong
- Department of Hypertension, Henan Province People’s Hospital, Zheng Zhou, China
| | - Xiao-Lin Sun
- Department of Hypertension, Henan Province People’s Hospital, Zheng Zhou, China
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22
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Espitia O, Bruneval P, Assaraf M, Pouchot J, Liozon E, de Boysson H, Gaudric J, Chiche L, Achouh P, Roussel JC, Miranda S, Mirault T, Boussouar S, Redheuil A, Serfaty JM, Bénichou A, Agard C, Guédon AF, Cacoub P, Paraf F, Fouret PJ, Toquet C, Biard L, Saadoun D. Long-Term Outcome and Prognosis of Noninfectious Thoracic Aortitis. J Am Coll Cardiol 2023; 82:1053-1064. [PMID: 37673506 DOI: 10.1016/j.jacc.2023.06.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/22/2023] [Accepted: 06/12/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Aortitis is a group of disorders characterized by the inflammation of the aorta. The large-vessel vasculitides are the most common causes of aortitis. Aortitis long-term outcomes are not well known. OBJECTIVES The purpose of this study was to assess the long-term outcome and prognosis of noninfectious surgical thoracic aortitis. METHODS This was a retrospective multicenter study of 5,666 patients with thoracic aorta surgery including 217 (3.8%) with noninfectious thoracic aortitis (118 clinically isolated aortitis, 57 giant cells arteritis, 21 Takayasu arteritis, and 21 with various systemic autoimmune disorders). Factors associated with vascular complications and a second vascular procedure were assessed by multivariable analysis. RESULTS Indications for aortic surgery were asymptomatic aneurysm with a critical size (n = 152 [70%]), aortic dissection (n = 28 [13%]), and symptomatic aortic aneurysm (n = 30 [14%]). The 10-year cumulative incidence of vascular complication and second vascular procedure was 82.1% (95% CI: 67.6%-90.6%), and 42.6% (95% CI: 28.4%-56.1%), respectively. Aortic arch aortitis (HR: 2.08; 95% CI: 1.26-3.44; P = 0.005) was independently associated with vascular complications. Descending thoracic aortitis (HR: 2.35; 95% CI: 1.11-4.96; P = 0.031) and aortic dissection (HR: 3.08; 95% CI: 1.61-5.90; P = 0.002) were independently associated with a second vascular procedure, while treatment with statins after aortitis diagnosis (HR: 0.47; 95% CI: 0.24-0.90; P = 0.028) decreased it. After a median follow-up of 3.9 years, 19 (16.1%) clinically isolated aortitis patients developed features of a systemic inflammatory disease and 35 (16%) patients had died. CONCLUSIONS This multicenter study shows that 82% of noninfectious surgical thoracic aortitis patients will experience a vascular complication within 10 years. We pointed out specific characteristics that identified those at highest risk for subsequent vascular complications and second vascular procedures.
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Affiliation(s)
- Olivier Espitia
- Nantes Université, CHU Nantes, Department of Vascular Medicine, Nantes, France; l'institut du thorax, INSERM UMR1087/CNRS UMR 6291, Team III Vascular & Pulmonary diseases, Nantes, France.
| | - Patrick Bruneval
- Department of cardiology, Hôpital Européen Georges Pompidou, Paris, France
| | - Morgane Assaraf
- Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire (CEREMAIA), Paris, France; INSERM, UMR_S 959, Paris, France; DMU 3ID, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Jacques Pouchot
- Department of Internal Medicine, Hôpital Européen Georges Pompidou, Paris, France
| | - Eric Liozon
- Department of Internal Medicine, CHU Limoges, France
| | | | - Julien Gaudric
- Department of Vascular Surgery, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Laurent Chiche
- Department of Vascular Surgery, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Paul Achouh
- Department of Cardiothoracic Surgery, Hôpital Européen Georges Pompidou, Paris, France
| | - Jean-Christian Roussel
- Department of Cardiothoracic Surgery, Nantes Université, CHU Nantes, Department of Internal and Vascular Medicine, Nantes, France
| | | | - Tristan Mirault
- Université Paris Cité, Department of Vascular Medicine, Hôpital Européen Georges Pompidou, APHP, INSERM U970 PARCC, Paris, France
| | - Samia Boussouar
- Sorbonne Universités, Pitié-Salpêtrière University Hospital, Department of Cardiovascular Imaging, Paris, France
| | - Alban Redheuil
- Sorbonne Universités, Pitié-Salpêtrière University Hospital, Department of Cardiovascular Imaging, Paris, France
| | - Jean-Michel Serfaty
- Nantes Université, CHU Nantes, Department of Cardiovascular Imaging, Nantes, France
| | - Antoine Bénichou
- Nantes Université, CHU Nantes, Department of Vascular Medicine, Nantes, France; l'institut du thorax, INSERM UMR1087/CNRS UMR 6291, Team III Vascular & Pulmonary diseases, Nantes, France
| | - Christian Agard
- Nantes Université, CHU Nantes, Department of Vascular Medicine, Nantes, France; l'institut du thorax, INSERM UMR1087/CNRS UMR 6291, Team III Vascular & Pulmonary diseases, Nantes, France
| | - Alexis F Guédon
- Nantes Université, CHU Nantes, Department of Vascular Medicine, Nantes, France; l'institut du thorax, INSERM UMR1087/CNRS UMR 6291, Team III Vascular & Pulmonary diseases, Nantes, France
| | - Patrice Cacoub
- Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire (CEREMAIA), Paris, France; INSERM, UMR_S 959, Paris, France; DMU 3ID, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | | | - Pierre-Jean Fouret
- Sorbonne Universités, Pitié-Salpêtrière University Hospital, Service d'anatomopathologie, UPMC-Paris VI, Paris, France
| | - Claire Toquet
- Nantes Université, CHU Nantes, Department of Pathology, Nantes, France
| | - Lucie Biard
- APHP Department of Biostatistics and Medical Information, Saint-Louis Hospital, Paris, France; ECSTRRA Team, CRESS UMR 1153, INSERM, Paris Cité University, Paris, France
| | - David Saadoun
- Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire (CEREMAIA), Paris, France; INSERM, UMR_S 959, Paris, France; DMU 3ID, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
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23
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Ridley DJ, Roach JK, Spencer CD, Singh KE. Case Report of Ascending Aortitis Mimicking Type A Intramural Hematoma by Multiple Imaging Modalities. A A Pract 2023; 17:e01684. [PMID: 37335878 DOI: 10.1213/xaa.0000000000001684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Affiliation(s)
- Daniel J Ridley
- From the Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
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24
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Wang YJ, Chen YY, Lin GH. Relationship between intralobar pulmonary sequestration and type A aortic dissection: A case report. World J Clin Cases 2023; 11:3658-3663. [PMID: 37383900 PMCID: PMC10294189 DOI: 10.12998/wjcc.v11.i15.3658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/26/2023] [Accepted: 04/17/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Pulmonary sequestrations often lead to serious complications such as infections, tuberculosis, fatal hemoptysis, cardiovascular problems, and even malignant degeneration, but it is rarely documented with medium and large vessel vasculitis, which is likely to result in acute aortic syndromes.
CASE SUMMARY A 44-year-old man with a history of acute Stanford type A aortic dissection status post-reconstructive surgery five years ago. The contrast-enhanced computed tomography of the chest at that time had also revealed an intralobar pulmonary sequestration in the left lower lung region, and the angiography also presented perivascular changes with mild mural thickening and wall enhancement, which indicated mild vasculitis. The intralobar pulmonary sequestration in the left lower lung region was long-term unprocessed, which was probably associated with his intermittent chest tightness since no specific medical findings were detected but only positive sputum culture with mycobacterium avium-intracellular complex and Aspergillus. We performed uniportal video-assisted thoracoscopic surgery with wedge resection of the left lower lung. Hypervascularity over the parietal pleura, engorgement of the bronchus due to a moderate amount of mucus, and firm adhesion of the lesion to the thoracic aorta were histopathologically noticed.
CONCLUSION We hypothesized that a long-term pulmonary sequestration-related bacterial or fungal infection can result in focal infectious aortitis gradually, which may threateningly aggravate the formation of aortic dissection.
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Affiliation(s)
- Yi-Jie Wang
- Department of Surgery, Tri Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Ying-Yi Chen
- Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Gang-Hua Lin
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
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25
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Misra DP, Singh K, Sharma A, Agarwal V. Arterial wall fibrosis in Takayasu arteritis and its potential for therapeutic modulation. Front Immunol 2023; 14:1174249. [PMID: 37256147 PMCID: PMC10225504 DOI: 10.3389/fimmu.2023.1174249] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 04/20/2023] [Indexed: 06/01/2023] Open
Abstract
Arterial wall damage in Takayasu arteritis (TAK) can progress despite immunosuppressive therapy. Vascular fibrosis is more prominent in TAK than in giant cell arteritis (GCA). The inflamed arterial wall in TAK is infiltrated by M1 macrophages [which secrete interleukin-6 (IL-6)], which transition to M2 macrophages once the inflammation settles. M2 macrophages secrete transforming growth factor beta (TGF-β) and glycoprotein non-metastatic melanoma protein B (GPNMB), both of which can activate fibroblasts in the arterial wall adventitia. Mast cells in the arterial wall of TAK also activate resting adventitial fibroblasts. Th17 lymphocytes play a role in both TAK and GCA. Sub-populations of Th17 lymphocytes, Th17.1 lymphocytes [which secrete interferon gamma (IFN-γ) in addition to interleukin-17 (IL-17)] and programmed cell death 1 (PD1)-expressing Th17 (which secrete TGF-β), have been described in TAK but not in GCA. IL-6 and IL-17 also drive fibroblast activation in the arterial wall. The Th17 and Th1 lymphocytes in TAK demonstrate an activation of mammalian target organ of rapamycin 1 (mTORC1) driven by Notch-1 upregulation. A recent study reported that the enhanced liver fibrosis score (derived from serum hyaluronic acid, tissue inhibitor of metalloproteinase 1, and pro-collagen III amino-terminal pro-peptide) had a moderate-to-strong correlation with clinically assessed and angiographically assessed vascular damage. In vitro experiments suggest the potential to target arterial wall fibrosis in TAK with leflunomide, tofacitinib, baricitinib, or mTORC1 inhibitors. Since arterial wall inflammation is followed by fibrosis, a strategy of combining immunosuppressive agents with drugs that have an antifibrotic effect merits exploration in future clinical trials of TAK.
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Affiliation(s)
- Durga Prasanna Misra
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - Kritika Singh
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - Aman Sharma
- Clinical Immunology and Rheumatology Services, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
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26
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Cox K, Sundaram RD, Popescu M, Pillai K, Kermali M, Harky A. A review on the deeper understanding of inflammation and infection of the thoracic aorta. Vascular 2023; 31:257-265. [PMID: 35469491 PMCID: PMC10021126 DOI: 10.1177/17085381211060928] [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: 11/17/2022]
Abstract
OBJECTIVE To review the current literature regarding infection and inflammation of the thoracic aorta and to summarise its aetiologies, pathogenesis and clinical presentation. Additionally, the authors sought to compare diagnostic methods and to analyse the different management options. METHOD A comprehensive electronic search using PubMed, MEDLINE, Scopus and Google Scholar was conducted to find relevant journal articles with key search terms including: 'aortitis', 'thoracic aortic infection' and 'surgical management of infected thoracic aortic aneurysms'. Prominent publications from 1995 till present (2021) were analysed to achieve a deeper understanding of thoracic aorta infection and inflammation, and the information was then collated to form this review. RESULTS The literature review revealed that infectious causes are more prominent than non-infectious causes, with Gram positive bacteria such as Staphylococcus, Enterococcus and Streptococcus accounting for approximately 60% of the infections. The authors also noted that Staphylococcus Aureus was associated with poorer outcomes. Key diagnostic tools include MRI and multi-slice CT imaging, which are useful imaging modalities in defining the extent of the disease thus allowing for planning surgical intervention. Surgical intervention itself is extremely multifaceted and the rarity of the condition means no large-scale comparative research between all the management options exists. Until more large-scale comparative data becomes available to guide treatment, the optimal approach must be decided on a case-by-case basis, considering the benefits and drawback of each treatment option. CONCLUSION A high index of suspicion and a comprehensive history is required to effectively diagnose and manage infection and inflammation of the thoracic aorta. Differentiating between infectious and inflammatory cases is crucial for management planning, as infectious causes typically require antibiotics and surgical intervention. Over the years, the post treatment results have shown significant improvement due to earlier diagnosis, advancement in surgical options and increasingly specific microbial therapy.
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Affiliation(s)
- Kofi Cox
- Faculty of Medicine, RinggoldID:4915St George's Hospital Medical School, University of London, London, UK
| | | | - Mara Popescu
- Faculty of Medicine, RinggoldID:405987King's College London, London, UK
| | - Kiran Pillai
- Faculty of Medicine, RinggoldID:4915St George's Hospital Medical School, University of London, London, UK
| | - Muhammed Kermali
- Faculty of Medicine, RinggoldID:4915St George's Hospital Medical School, University of London, London, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, RinggoldID:156669Liverpool Heart and Chest Hospital, Chester, UK
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27
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Cardiac involvement and cardiovascular risk factors in pediatric primary systemic vasculitides. Clin Rheumatol 2023; 42:673-686. [PMID: 36369404 DOI: 10.1007/s10067-022-06434-2] [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: 08/29/2022] [Revised: 10/25/2022] [Accepted: 11/01/2022] [Indexed: 11/13/2022]
Abstract
Pediatric primary systemic vasculitides are a complex group of diseases. Vasculitis subgroups are mainly determined according to the size of the predominantly affected vessels. In patients with primary systemic vasculitis, the location of vascular involvement, the size of the vessels, the extent of vascular damage, and the underlying pathology determine the disease phenotype and severity. Cardiac involvement is rare in some pediatric vasculitis, such as IgA vasculitis and polyarteritis nodosa, while it is more common in some others like Kawasaki disease and Takayasu arteritis. On the other hand, chronic inflammation in the setting of systemic vasculitis forms a major cardiovascular risk factor. Accelerated atherosclerosis and the tendency to thrombosis are the main issues determining the cardiovascular risks in pediatric systemic vasculitis. Early diagnosis and treatment are essential in these patients to minimize morbidity and mortality. In this review, we aimed to raise physicians' awareness of cardiac involvement and cardiovascular risks in pediatric patients with primary systemic vasculitis.
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28
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King CJ, Ngo TH, Constante M. Meningovascular Neurosyphilis Presenting as Multiple Ischemic Infarcts in a Young Adult. Cureus 2023; 15:e36405. [PMID: 37090294 PMCID: PMC10115213 DOI: 10.7759/cureus.36405] [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] [Accepted: 03/19/2023] [Indexed: 04/25/2023] Open
Abstract
Neurosyphilis occurs when the spirochete Treponema pallidum invades the cerebrospinal fluid (CSF). Clinical presentation depends on an individual's immune response and invasion location, with all possible involvement of meningeal, vascular, and/or parenchymatous tissues. Meningovascular neurosyphilis occurs when both the meninges and vasculature are affected and can lead to headaches, photophobia, neck stiffness, cranial nerve palsies, and/or ischemic brain infarctions due to infectious arteritis. The following report describes the rare case of a 32-year-old male patient presenting with multiple ischemic brain infarctions of varying ages. The stepwise diagnostic approach as described allowed the medical team to reach the final diagnosis of meningovascular neurosyphilis with concomitant acquired immunodeficiency syndrome (AIDS). This case emphasizes the importance of maintaining high clinical suspicion in all young adult patients who present with acute neurological deficits.
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Affiliation(s)
| | - Teresa H Ngo
- Neurology, Western University of Health Sciences, Pomona, USA
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Lohani KR, Sannasi VV, Sidhu HRS, Ooi OC, Hung WP, Chen MQ. Post-COVID-19 Thoracic Aortic Rupture with an Unforeseen Spinal Epidural Hematoma. AORTA (STAMFORD, CONN.) 2023; 11:40-43. [PMID: 36848911 PMCID: PMC9970752 DOI: 10.1055/s-0042-1757799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
The importance of prompt diagnosis and early stenting of an aortic rupture cannot be overemphasized. We present a case of thoracic aortic rupture in a middle-aged gentleman who had recently suffered coronavirus disease 2019. The case was further complicated by the development of an unexpected spinal epidural hematoma.
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Affiliation(s)
- Kush R. Lohani
- Division of Vascular Surgery, Department of General Surgery, Ng Teng Fong General Hospital, National University Health System, Singapore, Singapore,Address for correspondence Kush R. Lohani, MBBS, MS (Gen Surgery) Division of Vascular Surgery, Department of General Surgery, Ng Teng Fong General Hospital, National University Health System1 Jurong East Street 21, Singapore 609606Singapore
| | - Vikram V. Sannasi
- Division of Vascular Surgery, Department of General Surgery, Ng Teng Fong General Hospital, National University Health System, Singapore, Singapore
| | - Harvinder R. S. Sidhu
- Division of Vascular Surgery, Department of General Surgery, Ng Teng Fong General Hospital, National University Health System, Singapore, Singapore
| | - Oon C. Ooi
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore
| | - Wu P. Hung
- Department of Orthopedic Surgery, Ng Teng Fong General Hospital, National University Health System, Singapore, Singapore
| | - Min Q. Chen
- Division of Vascular Surgery, Department of General Surgery, Ng Teng Fong General Hospital, National University Health System, Singapore, Singapore
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30
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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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31
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Carrer M, Vignals C, Berard X, Caradu C, Battut AS, Stenson K, Neau D, Lazaro E, Mehlen M, Barret A, Nyamankolly E, Lifermann F, Rispal P, Illes G, Rouanes N, Caubet O, Poirot-Mazeres S, Vareil MO, Alleman L, Millon A, Huvelle U, Valour F, Ferry T, Cazanave C, Puges M. Retrospective Multicenter Study Comparing Infectious and Noninfectious Aortitis. Clin Infect Dis 2023; 76:e1369-e1378. [PMID: 35792621 DOI: 10.1093/cid/ciac560] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 06/27/2022] [Accepted: 07/01/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Determining the etiology of aortitis is often challenging, in particular to distinguish infectious aortitis (IA) and noninfectious aortitis (NIA). This study aims to describe and compare the clinical, biological, and radiological characteristics of IA and NIA and their outcomes. METHODS A multicenter retrospective study was performed in 10 French centers, including patients with aortitis between 1 January 2014 and 31 December 2019. RESULTS One hundred eighty-three patients were included. Of these, 66 had IA (36.1%); the causative organism was Enterobacterales and streptococci in 18.2% each, Staphylococcus aureus in 13.6%, and Coxiella burnetii in 10.6%. NIA was diagnosed in 117 patients (63.9%), mainly due to vasculitides (49.6%), followed by idiopathic aortitis (39.3%). IA was more frequently associated with aortic aneurysms compared with NIA (78.8% vs 17.6%, P < .001), especially located in the abdominal aorta (69.7% vs 23.1%, P < .001). Crude and adjusted survival were significantly lower in IA compared to NIA (P < .001 and P = .006, respectively). In the IA cohort, high American Society of Anesthesiologists score (hazard ratio [HR], 2.47 [95% confidence interval {CI}, 1.08-5.66]; P = .033) and free aneurysm rupture (HR, 9.54 [95% CI, 1.04-87.11]; P = .046) were significantly associated with mortality after adjusting for age, sex, and Charlson comorbidity score. Effective empiric antimicrobial therapy, initiated before any microbial documentation, was associated with a decreased mortality (HR, 0.23, 95% CI, .08-.71]; P = .01). CONCLUSIONS IA was complicated by significantly higher mortality rates compared with NIA. An appropriate initial antibiotic therapy appeared as a protective factor in IA.
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Affiliation(s)
- Mathilde Carrer
- Infectious and Tropical Diseases Department, Centre hospitalier universitaire Bordeaux, Bordeaux, France
| | - Carole Vignals
- Infectious and Tropical Diseases Department, Centre hospitalier universitaire Bordeaux, Bordeaux, France
| | - Xavier Berard
- Department of Vascular Surgery, Centre hospitalier universitaire Bordeaux, Bordeaux, France
| | - Caroline Caradu
- Department of Vascular Surgery, Centre hospitalier universitaire Bordeaux, Bordeaux, France
| | - Anne-Sophie Battut
- Department of Vascular Surgery, Clinique Mutualiste de Pessac, Pessac, France
| | - Katherine Stenson
- St George's University Hospitals NHS Foundation Trust, Imperial College Healthcare, London, United Kingdom
| | - Didier Neau
- Infectious and Tropical Diseases Department, Centre hospitalier universitaire Bordeaux, Bordeaux, France
| | - Estibaliz Lazaro
- Internal Medicine and Infectious Disease Department, Centre hospitalier universitaire Bordeaux, Bordeaux, France
| | - Maxime Mehlen
- Infectious and Tropical Diseases Department, Centre hospitalier universitaire Bordeaux, Bordeaux, France
| | - Amaury Barret
- Internal Medicine and Infectious Diseases Department, Centre hospitalier Arcachon, Arcachon, France
| | - Elsa Nyamankolly
- Infectious and Tropical Diseases Department, Centre hospitalier Dax, Dax, France
| | | | - Patrick Rispal
- Infectious and Tropical Diseases Department, Centre hospitalier Agen, Agen, France
| | - Gabriela Illes
- Infectious and Tropical Diseases Department, Centre hospitalier Mont de Marsan, Mont de Marsan, France
| | - Nicolas Rouanes
- Polyvalent Medicine Department, Centre hospitalier Périgueux, Périgueux, France
| | - Olivier Caubet
- Internal Medicine Department, Centre hospitalier Libourne, Libourne, France
| | | | - Marc-Olivier Vareil
- Infectious and Tropical Diseases Department, Centre hospitalier Bayonne, Bayonne, France
| | - Laure Alleman
- Infectious and Tropical Diseases Department, Centre hospitalier Bayonne, Bayonne, France
| | - Antoine Millon
- Department of Vascular Surgery, Centre hospitalier universitaire Lyon, Lyon, France
| | - Ugo Huvelle
- Department of Vascular Surgery, Centre hospitalier universitaire Lyon, Lyon, France
| | - Florent Valour
- Infectious and Tropical Diseases Department, Centre hospitalier universitaire Lyon, Lyon, France
| | - Tristan Ferry
- Infectious and Tropical Diseases Department, Centre hospitalier universitaire Lyon, Lyon, France
| | - Charles Cazanave
- Infectious and Tropical Diseases Department, Centre hospitalier universitaire Bordeaux, Bordeaux, France
| | - Mathilde Puges
- Infectious and Tropical Diseases Department, Centre hospitalier universitaire Bordeaux, Bordeaux, France
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32
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van der Geest KS, Slijkhuis BG, Tomelleri A, Gheysens O, Jiemy WF, Piccolo C, Nienhuis P, Sandovici M, Brouwer E, Glaudemans AW, Mulder DJ, Slart RH. Positron Emission Tomography Imaging in Vasculitis. Cardiol Clin 2023; 41:251-265. [PMID: 37003681 DOI: 10.1016/j.ccl.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Systemic vasculitides comprise a group of autoimmune diseases affecting blood vessels. [18F]-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (FDG-PET/CT) plays an important role in the diagnosis and therapeutic monitoring of vasculitides affecting large-sized and medium-sized vessels. FDG-PET/CT also provides complementary information to other vascular imaging tools. The resolution and sensitivity of newer generation scanners continues to increase, hereby improving the ability of FDG-PET/CT to accurately assess the full disease extent in patients with vasculitis. Novel tracers targeting specific immune cells will allow for more detailed detection of vascular infiltrates.
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33
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Tandogar N, Öcalmaz M. Mycotic abdominal aortic aneurysm: two cases caused by Salmonella enterica. Cardiovasc J Afr 2023; 34:59-62. [PMID: 35687079 PMCID: PMC10392802 DOI: 10.5830/cvja-2022-024] [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: 02/11/2022] [Accepted: 05/10/2022] [Indexed: 06/07/2023] Open
Abstract
A mycotic abdominal aortic aneurysm was detected on computed tomographic angiography of two male patients who were followed up after reporting symptoms of abdominal pain, malaise and fever of unknown origin. One of the patients' aneurysm was repaired with a tubular graft and the other patient had endovascular aneurysm repair due to his high co-morbidity. From pre-operative cultures and a pathological examination of the surgical specimens, it was observed that the aneurysms had developed in the abdominal aorta due to Salmonella enterica, and broad-spectrum antibiotic therapy was started. We present these two cases of mycotic aneurysm due to Salmonella. The patients were discharged after the postoperative course of antibiotic treatments were completed.
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Affiliation(s)
- Nehir Tandogar
- Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
| | - M Öcalmaz
- Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Miller M, Li J, Khalaf SA, Nelson TB. Capnocytophaga aortitis: A dog's gift to its owner. IDCases 2023; 32:e01763. [PMID: 37114208 PMCID: PMC10127112 DOI: 10.1016/j.idcr.2023.e01763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
We present a case of Capnocytophaga aortitis in an 82-year-old male with fever, weakness, confusion, and back pain. Diagnosis was established following a ruptured abdominal aortic aneurysm and subsequent blood culture growth of Capnocytophaga species. He was treated with endovascular aortic repair in addition to a six-week course of ceftriaxone followed by long-term antibiotic suppression with amoxicillin-clavulanate. Capnocytophaga aortitis is exceedingly rare and poorly described in current literature.
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Affiliation(s)
- Michael Miller
- Department of Medicine, University of Missouri, Columbia, MO, United States of America
- Correspondence to: Department of Medicine, University of Missouri-Columbia, 1 Hospital Drive, Columbia, MO 65212, United States of America.
| | - Jessie Li
- Department of Medicine, University of Missouri, Columbia, MO, United States of America
| | - Suha Abu Khalaf
- Department of Medicine, Division of Infectious Diseases, University of Missouri, Columbia, MO, United States of America
| | - Taylor B. Nelson
- Department of Medicine, Division of Infectious Diseases, University of Missouri, Columbia, MO, United States of America
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35
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Saeed M, Malahfji M. Medical Management of Aortic Disease: If They Don't Need Surgery, What Do They Need? Methodist Debakey Cardiovasc J 2023; 19:70-77. [PMID: 36910548 PMCID: PMC10000319 DOI: 10.14797/mdcvj.1192] [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: 11/24/2022] [Accepted: 01/13/2023] [Indexed: 03/09/2023] Open
Abstract
Management of aortic disease has evolved significantly over the past few decades. A preemptive diagnostic approach with a multidisciplinary team and shared decision-making has led to improved clinical outcomes. Surgery is the cornerstone of management for most aortic conditions; however, medical therapy is now an important adjunctive therapy in most if not all patients. Herein, we review the role and evidence behind medical management of patients with aortic disease.
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Affiliation(s)
- Mujtaba Saeed
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
| | - Maan Malahfji
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
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36
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Mayer A, Sperry A, Quimson L, Rhee RL. Long-Term Clinical and Radiographic Outcomes in Patients With Clinically Isolated Aortitis. ACR Open Rheumatol 2022; 4:1013-1020. [PMID: 36250477 DOI: 10.1002/acr2.11504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/02/2022] [Accepted: 09/08/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The optimal management of patients with incidentally found clinically isolated aortitis (CIA) after aneurysm repair is unclear. This study compared long-term surgical and clinical outcomes after surgical repair of thoracic aortic aneurysm between patients with CIA and patients with noninflammatory etiologies. METHODS This is a matched cohort study. Patients with CIA were identified by histopathology following open thoracic aortic aneurysm repair. Two comparators without inflammation on pathology were matched to each patient by year of surgical repair. Outcomes included surgical complications, new vascular abnormalities on imaging, and death. RESULTS One hundred sixty-two patients were included: 53 with CIA and 109 matched comparators. Median follow-up time was similar between groups (CIA 3.7 vs. comparator 3.3 years, P = 0.64). There was no difference in postoperative complications, surgical revision, or death between groups. Only 32% of patients with CIA saw a rheumatologist in the outpatient setting and 33% received immunosuppressive treatment. On surveillance imaging, no difference was seen in new or worsening aortic aneurysms, but there were significantly more vascular abnormalities in branch arteries of the thoracic aorta in patients with CIA (39% vs. 11%, P < 0.01). CONCLUSION Among patients who underwent surgical repair of a thoracic aortic aneurysm, patients with CIA were more likely than noninflammatory comparators to develop radiographic abnormalities in aortic branch arteries. Notably, there was no difference in risk of new aortic aneurysms or surgical complications despite most patients with CIA never receiving immunosuppression. This suggests that more selective initiation of immunosuppression in CIA may be considered after aortic aneurysm repair.
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Affiliation(s)
- Adam Mayer
- The University of Pennsylvania and the Children's Hospital of Philadelphia, Philadelphia
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37
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Datta M, Pradeep S, Aditya M. Rare case of infective aortitis with aortic rupture and cardiac tamponade in a young child. BMJ Case Rep 2022; 15:e250543. [PMID: 36455981 PMCID: PMC9717215 DOI: 10.1136/bcr-2022-250543] [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: 12/05/2022] Open
Abstract
Aortitis and aortic dissection are very rare in children. The clinical presentation of aortitis varies across a spectrum, ranging from incidental findings to fatal aortic dissection and rupture. A high index of suspicion is needed to establish an accurate and timely diagnosis. Here, we present an unfortunate case of fatal infective aortitis with aortic rupture and cardiac tamponade in a healthy toddler. Postmortem report implicated Kingella kingae as the causative organism of aortic pseudoaneurysm and rupture, leading to the instantaneous death of the child.
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Affiliation(s)
- Manas Datta
- Department of Paediatrics, Broomfield Hospital, Mid and South Essex NHS Foundation trust, Chelmsford, UK
| | - Sangeetha Pradeep
- Department of Paediatrics, Broomfield Hospital, Mid and South Essex NHS Foundation trust, Chelmsford, UK
| | - Mainak Aditya
- Department of Paediatrics, Broomfield Hospital, Mid and South Essex NHS Foundation trust, Chelmsford, UK
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Volpini X, Natali L, Brugo MB, de la Cruz-Thea B, Baigorri RE, Cerbán FM, Fozzatti L, Motran CC, Musri MM. Trypanosoma cruzi Infection Promotes Vascular Remodeling and Coexpression of α-Smooth Muscle Actin and Macrophage Markers in Cells of the Aorta. ACS Infect Dis 2022; 8:2271-2290. [PMID: 36083791 DOI: 10.1021/acsinfecdis.2c00318] [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: 01/29/2023]
Abstract
Chagas disease is an emerging global health problem; however, it remains neglected. Increased aortic stiffness (IAS), a predictor of cardiovascular events, has recently been reported in asymptomatic chronic Chagas patients. After vascular injury, smooth muscle cells (SMCs) can undergo alterations associated with phenotypic switch and transdifferentiation, promoting vascular remodeling and IAS. By studying different mouse aortic segments, we tested the hypothesis that Trypanosoma cruzi infection promotes vascular remodeling. Interestingly, the thoracic aorta was the most affected by the infection. Decreased expression of SMC markers and increased expression of proliferative markers were observed in the arteries of acutely infected mice. In acutely and chronically infected mice, we observed cells coexpressing SMC and macrophage (Mo) markers in the media and adventitia layers of the aorta, indicating that T. cruzi might induce cellular processes associated with SMC transdifferentiation into Mo-like cells or vice versa. In the adventitia, the Mo cell functional polarization was associated with an M2-like CD206+arginase-1+ phenotype despite the T. cruzi presence in the tissue. Only Mo-like cells in inflammatory foci were CD206+iNOS+. In addition to the disorganization of elastic fibers, we found thickening of the aortic layers during the acute and chronic phases of the disease. Our findings indicate that T. cruzi infection induces a vascular remodeling with SMC dedifferentiation and increased cell populations coexpressing α-SMA and Mo markers that could be associated with IAS promotion. These data highlight the importance of studying large vessel homeostasis in Chagas disease.
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Affiliation(s)
- Ximena Volpini
- Instituto de Investigaciones Médicas Mercedes y Martín Ferreyra. Consejo Nacional de Investigaciones Científicas y Tecnicas. Universidad Nacional de Córdoba (INIMEC-CONICET-UNC), Friuli 2434. Colinas de Velez Sarfield, Córdoba, PC X5016NST, Argentina.,Centro de Investigaciones en Bioquímica Clínica e Inmunología. Consejo Nacional de Investigaciones Científicas y Técnicas (CIBICI-CONICET), Haya de la Torre y Medina Allende. Ciudad Universitaria, Córdoba, PC X5000HUA, Argentina.,Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba (FCQ-UNC). Ciudad Universitaria, Córdoba, PC X5000HUA, Argentina
| | - Lautaro Natali
- Instituto de Investigaciones Médicas Mercedes y Martín Ferreyra. Consejo Nacional de Investigaciones Científicas y Tecnicas. Universidad Nacional de Córdoba (INIMEC-CONICET-UNC), Friuli 2434. Colinas de Velez Sarfield, Córdoba, PC X5016NST, Argentina.,Centro de Investigaciones en Bioquímica Clínica e Inmunología. Consejo Nacional de Investigaciones Científicas y Técnicas (CIBICI-CONICET), Haya de la Torre y Medina Allende. Ciudad Universitaria, Córdoba, PC X5000HUA, Argentina
| | - Maria Belén Brugo
- Centro de Investigaciones en Bioquímica Clínica e Inmunología. Consejo Nacional de Investigaciones Científicas y Técnicas (CIBICI-CONICET), Haya de la Torre y Medina Allende. Ciudad Universitaria, Córdoba, PC X5000HUA, Argentina.,Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba (FCQ-UNC). Ciudad Universitaria, Córdoba, PC X5000HUA, Argentina
| | - Benjamin de la Cruz-Thea
- Instituto de Investigaciones Médicas Mercedes y Martín Ferreyra. Consejo Nacional de Investigaciones Científicas y Tecnicas. Universidad Nacional de Córdoba (INIMEC-CONICET-UNC), Friuli 2434. Colinas de Velez Sarfield, Córdoba, PC X5016NST, Argentina
| | - Ruth Eliana Baigorri
- Centro de Investigaciones en Bioquímica Clínica e Inmunología. Consejo Nacional de Investigaciones Científicas y Técnicas (CIBICI-CONICET), Haya de la Torre y Medina Allende. Ciudad Universitaria, Córdoba, PC X5000HUA, Argentina.,Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba (FCQ-UNC). Ciudad Universitaria, Córdoba, PC X5000HUA, Argentina
| | - Fabio Marcelo Cerbán
- Centro de Investigaciones en Bioquímica Clínica e Inmunología. Consejo Nacional de Investigaciones Científicas y Técnicas (CIBICI-CONICET), Haya de la Torre y Medina Allende. Ciudad Universitaria, Córdoba, PC X5000HUA, Argentina.,Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba (FCQ-UNC). Ciudad Universitaria, Córdoba, PC X5000HUA, Argentina
| | - Laura Fozzatti
- Centro de Investigaciones en Bioquímica Clínica e Inmunología. Consejo Nacional de Investigaciones Científicas y Técnicas (CIBICI-CONICET), Haya de la Torre y Medina Allende. Ciudad Universitaria, Córdoba, PC X5000HUA, Argentina.,Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba (FCQ-UNC). Ciudad Universitaria, Córdoba, PC X5000HUA, Argentina
| | - Claudia Cristina Motran
- Centro de Investigaciones en Bioquímica Clínica e Inmunología. Consejo Nacional de Investigaciones Científicas y Técnicas (CIBICI-CONICET), Haya de la Torre y Medina Allende. Ciudad Universitaria, Córdoba, PC X5000HUA, Argentina.,Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba (FCQ-UNC). Ciudad Universitaria, Córdoba, PC X5000HUA, Argentina
| | - Melina Mara Musri
- Instituto de Investigaciones Médicas Mercedes y Martín Ferreyra. Consejo Nacional de Investigaciones Científicas y Tecnicas. Universidad Nacional de Córdoba (INIMEC-CONICET-UNC), Friuli 2434. Colinas de Velez Sarfield, Córdoba, PC X5016NST, Argentina.,Departamento de Fisiología, Facultad de Ciencias Exactas Físicas y Naturales. Universidad Nacional de Córdoba (FCEFyN-UNC). Av. Velez Sarfield 299, Centro, Córdoba, PC X5000JJC, Argentina
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Hur B, Koster MJ, Jang JS, Weyand CM, Warrington KJ, Sung J. Global Transcriptomic Profiling Identifies Differential Gene Expression Signatures Between Inflammatory and Noninflammatory Aortic Aneurysms. Arthritis Rheumatol 2022; 74:1376-1386. [PMID: 35403833 PMCID: PMC9902298 DOI: 10.1002/art.42138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/17/2022] [Accepted: 03/08/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To identify hallmark genes and biomolecular processes in aortitis using high-throughput gene expression profiling, and to provide a range of potentially new drug targets (genes) and therapeutics from a pharmacogenomic network analysis. METHODS Bulk RNA sequencing was performed on surgically resected ascending aortic tissues from inflammatory aneurysms (giant cell arteritis [GCA] with or without polymyalgia rheumatica, n = 8; clinically isolated aortitis [CIA], n = 17) and noninflammatory aneurysms (n = 25) undergoing surgical aortic repair. Differentially expressed genes (DEGs) between the 2 patient groups were identified while controlling for clinical covariates. A protein-protein interaction model, drug-gene target information, and the DEGs were used to construct a pharmacogenomic network for identifying promising drug targets and potentially new treatment strategies in aortitis. RESULTS Overall, tissue gene expression patterns were the most associated with disease state than with any other clinical characteristic. We identified 159 and 93 genes that were significantly up-regulated and down-regulated, respectively, in inflammatory aortic aneurysms compared to noninflammatory aortic aneurysms. We found that the up-regulated genes were enriched in immune-related functions, whereas the down-regulated genes were enriched in neuronal processes. Notably, gene expression profiles of inflammatory aortic aneurysms from patients with GCA were no different than those from patients with CIA. Finally, our pharmacogenomic network analysis identified genes that could potentially be targeted by immunosuppressive drugs currently approved for other inflammatory diseases. CONCLUSION We performed the first global transcriptomics analysis in inflammatory aortic aneurysms from surgically resected aortic tissues. We identified signature genes and biomolecular processes, while finding that CIA may be a limited presentation of GCA. Moreover, our computational network analysis revealed potential novel strategies for pharmacologic interventions and suggests future biomarker discovery directions for the precise diagnosis and treatment of aortitis.
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Affiliation(s)
- Benjamin Hur
- Microbiome Program, Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Surgery Research, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Matthew J. Koster
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jin Sung Jang
- Medical Genome Facility, Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Cornelia M. Weyand
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Jaeyun Sung
- Microbiome Program, Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Surgery Research, Department of Surgery, Mayo Clinic, Rochester, MN, USA
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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40
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Ludwig DR, Raptis CA, Bhalla S. Emergent Magnetic Resonance Angiography for Evaluation of the Thoracoabdominal and Peripheral Vasculature. Magn Reson Imaging Clin N Am 2022; 30:465-477. [PMID: 35995474 DOI: 10.1016/j.mric.2022.04.008] [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: 01/08/2023]
Abstract
Thoracoabdominal and peripheral vasculature pathologies include a variety of severe and life threatening conditions that may be encountered in the emergent setting. Computed tomography angiography (CTA) is the first-line modality for imaging of the vasculature in this context, but magnetic resonance angiography (MRA) also plays an important and emerging role in the evaluation of carefully selected patients. Intravenous (IV) iodinated contrast is necessary for CTA, although MRA is most useful in patients who cannot receive IV iodinated contrast for reasons including prior severe allergic-like reaction to iodinated contrast, poor IV access, or severe renal insufficiency. Gadolinium-based contrast agents are administered for MRA when possible, as they generally improve the diagnostic quality and shorten the duration of the exam. In most clinical situations, however, noncontrast MRA is sufficient to obtain a diagnostic evaluation. In this review, we discuss the key strengths and limitations of MRA performed in the emergent setting, highlighting the role of MRA in the diagnosis of acute aortic syndromes, aortitis, aortic aneurysm, pulmonary embolism, and peripheral vascular disease.
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Affiliation(s)
- Daniel R Ludwig
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, Campus Box 8131, Saint Louis, MO 63110, USA.
| | - Constantine A Raptis
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, Campus Box 8131, Saint Louis, MO 63110, USA
| | - Sanjeev Bhalla
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, Campus Box 8131, Saint Louis, MO 63110, USA.
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41
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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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Ninomiya R, Kinehara Y, Tobita S, Konaka H, Jokoji R, Shintani T, Tachibana I. Inflammatory Thoracic Aortic Aneurysm in a Patient with Advanced Lung Adenocarcinoma Treated with Pembrolizumab. Intern Med 2022; 61:2339-2341. [PMID: 35022350 PMCID: PMC9424081 DOI: 10.2169/internalmedicine.8688-21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
A 57-year-old man with lung adenocarcinoma was treated with chemotherapy and immune checkpoint blockade. After two cycles of carboplatin, pemetrexed, and pembrolizumab, he developed a persistent fever. Chest computed tomography (CT) suggested inflammation of the aortic wall. We treated the patient with corticosteroids. After four cycles of carboplatin, pemetrexed, and pembrolizumab, chest CT showed an aneurysm in the ascending aorta. We diagnosed him with inflammatory thoracic aortic aneurysm induced by pembrolizumab and performed surgical replacement of the ascending aorta. Although this might be a very rare case, we should be aware of aortitis as a potential adverse effect of pembrolizumab.
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Affiliation(s)
| | | | | | | | - Ryu Jokoji
- Department of Pathology, Nippon Life Hospital, Japan
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43
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Jules P, Valencia O, Valencia D, Reddy A, Ahmed R. Takayasu’s Arteritis With Acute Severe Aortic Regurgitation Requiring a Bio-Bentall Procedure. Cureus 2022; 14:e26969. [PMID: 35989796 PMCID: PMC9381860 DOI: 10.7759/cureus.26969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 11/24/2022] Open
Abstract
Aortitis is a rare form of vasculitis that is associated with significant morbidity and mortality through the development of aneurysms, aortic rupture, dissection, and thrombotic occlusions. Common causes for non-infectious large vessel vasculitis include Takayasu's arteritis and giant cell arteritis. Delayed diagnosis and treatment can be devastating, resulting in lifelong disability or death. Here we present an unfortunate case of Takayasu's arteritis with aortitis and acute severe aortic regurgitation in a young patient requiring an emergent Bio-Bentall procedure and bowel resection.
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44
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Beketova TV. Non-infectious diseases of the aorta and large arteries. TERAPEVT ARKH 2022; 94:695-703. [DOI: 10.26442/00403660.2022.05.201500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 06/17/2022] [Indexed: 11/22/2022]
Abstract
This article describes the various forms of inflammatory lesions of the aorta and large arteries, including chronic periaortitis, as well as the diagnostic methods are considered. Large vessel vasculitis represent the most common entities, however, there is also an association with other rheumatological or inflammatory diseases, drug-induced or paraneoplastic entities. Instrumental imaging modalities play an important role in the diagnosis.
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45
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Tsygankova OV, Bayramova SS, Akhmedzhanov NM. Nonspecific aortoarteritis as a Cause of Aortic Dissection in a Middle Aged Man. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2022. [DOI: 10.20996/1819-6446-2022-04-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Nonspecific aortoarteritis (Takayasu's disease) is a systemic inflammatory disease characterized by granulomatous lesions of the aorta and its large branches. The article describes the clinical manifestations, methods of diagnosis and treatment of this pathology. It also describes a clinical observation that illustrates the delayed diagnosis of the disease in a 47-year-old man, where Takayasu arteritis with lesions of the root, ascending aorta, both common carotid arteries, thoracic and abdominal aorta (type V according to the angiographic classification proposed by Moriwaki R.) manifested a syncopal state, just a few days before the development of a life – threatening complication-aortic dissection of type I according to the DeBakey classification. From a clinical point of view, it is important that Takayasu's disease does not always develop in young people, women, and Asian origin, and, unfortunately, it is often very late to diagnose, although the effectiveness of therapy, including surgical correction of this disease, is entirely determined by the timeliness of its diagnosis.
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Affiliation(s)
- O. V. Tsygankova
- Novosibirsk State Medical University; Research Institute of Internal and Preventive Medicine - Branch of the Federal Research Center Institute of Cytology and Genetics, Siberian Branch Russian Academy of Sciences
| | - S. S. Bayramova
- Research Institute of Internal and Preventive Medicine - Branch of the Federal Research Center Institute of Cytology and Genetics, Siberian Branch Russian Academy of Sciences
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46
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Choi E, Mathews LM, Paik J, Corretti MC, Wu KC, Michos ED, Hays AG, Mukherjee M. Multimodality Evaluation of Aortic Insufficiency and Aortitis in Rheumatologic Diseases. Front Cardiovasc Med 2022; 9:874242. [PMID: 35497991 PMCID: PMC9039512 DOI: 10.3389/fcvm.2022.874242] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/21/2022] [Indexed: 12/17/2022] Open
Abstract
Aortic insufficiency is commonly observed in rheumatologic diseases such as ankylosing spondylitis, systemic lupus erythematosus, antiphospholipid syndrome, Behçet's disease, granulomatosis with polyangiitis, and Takayasu arteritis. Aortic insufficiency with an underlying rheumatologic disease may be caused by a primary valve pathology (leaflet destruction, prolapse or restriction), annular dilatation due to associated aortitis or a combination of both. Early recognition of characteristic valve and aorta morphology on cardiac imaging has both diagnostic and prognostic importance. Currently, echocardiography remains the primary diagnostic tool for aortic insufficiency. Complementary use of computed tomography, cardiac magnetic resonance imaging and positron emission tomography in these systemic conditions may augment the assessment of underlying mechanism, disease severity and identification of relevant non-valvular/extracardiac pathology. We aim to review common rheumatologic diseases associated with aortic insufficiency and describe their imaging findings that have been reported in the literature.
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Affiliation(s)
- Eunjung Choi
- Dartmouth-Hitchcock Medical Center, Heart and Vascular Center, Lebanon, NH, United States
| | - Lena M. Mathews
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Julie Paik
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, United States
| | - Mary C. Corretti
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Katherine C. Wu
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Erin D. Michos
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Allison G. Hays
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Monica Mukherjee
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
- *Correspondence: Monica Mukherjee
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Buğra AK, Buğra A, Kadiroğulları E, Onan B. Incidentally detected aortitis during coronary bypass surgery: A case report. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2022; 30:267-271. [PMID: 36168564 PMCID: PMC9473598 DOI: 10.5606/tgkdc.dergisi.2022.22228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/19/2021] [Indexed: 06/16/2023]
Abstract
Aortitis is the inflammation of the aortic wall. In our case, in which we planned elective coronary bypass surgery, a firm and dilated ascending aorta with a pearlescent color was encountered intraoperatively. Histopathological examination revealed extensive lymphoplasmacytic infiltration and storiform fibrosis. Aortitis may be a component of a multisystemic or autoimmune disease. The time of diagnosis may coincide with the asymptomatic period of the systemic disease. This case was presented as it was incidentally detected during coronary bypass surgery and was histopathologically diagnosed as immunoglobulin G4-related aortitis, although it could not be diagnosed in clinical and laboratory evaluations.
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Affiliation(s)
- Abdul Kerim Buğra
- Department of Cardiovascular Surgery, Mehmet Akif Ersoy Thoracic Cardiovascular Surgery Training and Research Hospital, Istanbul, Türkiye
| | - Aytül Buğra
- Department of Histopathology, Council of Forensic Medicine, Istanbul, Türkiye
| | - Ersin Kadiroğulları
- Department of Cardiovascular Surgery, Mehmet Akif Ersoy Thoracic Cardiovascular Surgery Training and Research Hospital, Istanbul, Türkiye
| | - Burak Onan
- Department of Cardiovascular Surgery, Mehmet Akif Ersoy Thoracic Cardiovascular Surgery Training and Research Hospital, Istanbul, Türkiye
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Abstract
PURPOSE OF REVIEW The importance of cardiovascular disease (CVD) in women has long been underestimated. Therefore, we need to understand the impact of sex differences on CVD. RECENT FINDINGS Traditional risk factors contribute to coronary artery disease (CAD) differently in women and men. There are female-specific risk factors and comorbid conditions that affect the risk of CAD. Plaque erosion is frequently seen in younger women who smoke, while plaque rupture is common in older women and men who have elevated blood cholesterol. Coronary artery calcification is also different in both sexes. Thus, coronary artery calcification score-based risk stratification in women is challenging. A deeper understanding of the sex differences in the risk factors and plaque morphology of coronary atherosclerosis may lead to improved outcomes of CVD in women.
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Farkašová Iannaccone S, Koščo M, Ginelliová A, Sihotský V, Mistríková L, Dettmeyer R, Farkaš D. Fatal bleeding following left internal jugular vein cannulation associated with type A1 endoleak, false aneurysm and aortobronchopulmonary fistula. Rechtsmedizin (Berl) 2022. [DOI: 10.1007/s00194-022-00557-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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50
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Ballaith A, Raffort J, Rajhi K, Salucki B, Drai C, Jean-Baptiste E, Hassen-Khodja R, Lareyre F. Mycotic aortic and left iliac ruptured aneurysm due to Escherichia Coli: a case report and literature overview. Acta Chir Belg 2022; 122:56-62. [PMID: 32253984 DOI: 10.1080/00015458.2020.1753146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Mycotic aneurysm is a life-threatening disease often caused by Salmonella, Staphylococci and Streptococci species. Interestingly, Escherichia Coli (E. Coli) is described as a rare causative agent. We report the case of a patient who developed a mycotic aortic and ruptured left iliac aneurysm due to E. Coli. The patient developed a secondary aortic graft infection due to a mesenteric ischemia with fecal peritonitis. A literature overview of the current knowledge on mycotic aortic aneurysms specifically due to E. Coli is discussed including the clinical characteristics of patients, the management of the disease and the post-operative outcomes.
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Affiliation(s)
- Ali Ballaith
- Department of Vascular Surgery, University Hospital of Nice, Nice, France
| | - Juliette Raffort
- Department of Visceral Surgery, Université Côte d’Azur, CHU, Nice, France
- Clinical Chemistry Laboratory, University Hospital of Nice, Nice, France
| | - Khalid Rajhi
- Department of Vascular Surgery, University Hospital of Nice, Nice, France
| | - Benjamin Salucki
- Department of Visceral Surgery, University Hospital of Nice, Nice, France
| | - Céline Drai
- Department of Vascular Surgery, University Hospital of Nice, Nice, France
| | - Elixène Jean-Baptiste
- Department of Vascular Surgery, University Hospital of Nice, Nice, France
- Department of Visceral Surgery, Université Côte d’Azur, CHU, Nice, France
| | - Réda Hassen-Khodja
- Department of Vascular Surgery, University Hospital of Nice, Nice, France
- Department of Visceral Surgery, Université Côte d’Azur, CHU, Nice, France
| | - Fabien Lareyre
- Department of Vascular Surgery, University Hospital of Nice, Nice, France
- Department of Visceral Surgery, Université Côte d’Azur, CHU, Nice, France
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