Coarctation of the aorta associated with aneurysm of the left subclavian artery

Giant cell aortitis combined with arteritis and coarctation of the aorta in 3.5-month child: A case report and literature review

A present case showing giant cell aortitis (GGA) with coarctation of the aorta can be considered unique, even after reviewing the literature. The case of a 3.5-month-old girl who suffered an acute viral infection with an increase in body temperature (up to 39.5°C), difficulty breathing, and diarrhea is described. The girl was diagnosed with nasopharyngitis, enterocolitis, meningoencephalitis; she died 20 hours after being hospitalized from multiple organ failure. Clinical and laboratory data were collected, and a pathological examination was performed. Histological examination of the aorta and its main branches, such as the brachiocephalic trunk, left common carotid artery, left subclavian artery, as well as internal organs, was performed using hematoxylin-eosin, Hart's resorcin-fuchsin, Weigert's picrofuchsin, and Masson's trichrome. Pathological examination revealed giant cell aortitis and arteritis with coarctation of the aorta. GCA, in our case, had pathomorphological signs. First, many plaques that protruded into the lumen of the aorta and main branches, such as the brachiocephalic trunk, left common carotid artery and left subclavian artery, had a conical end that resembled the appearance of a rash. Second, granulomatous inflammation was localized in the intima of the aorta and all layers of the above-mentioned arteries. Our case of GCA in a 3.5-month-old girl is the youngest patient among those described. We first describe GCA in relation to other severe aortic diseases. Coarctation, in combination with an aneurysm of the ascending aorta and aortitis, is a pathology that has not yet been described.

Coarctation of the aorta with aortic and subclavian artery aneurysms

Coarctation of the aorta discovered in adulthood is uncommon. The formation of aneurysms from the coarctation segment and in the low-pressure area is even rarer. The surgical management of coarctations can be challenging due to calcifications and concomitant cardiovascular and lung disease. We present a case with coronary artery disease, bilateral bullae, left subclavian artery aneurysm, saccular aortic aneurysms originating proximal to the coarctation and from the coarctation itself, and a remnant of ductus arteriosus. The surgical management and possible histopathologic causes for aneurysm formation are discussed.

Current modalities in the diagnosis of pulmonary vasculitis

INTRODUCTION

This review addresses the pulmonary manifestations of the vasculitides, with a focus on diagnostic modalities. Haemorrhagic presentations (usually associated with nephritis: the pulmonary-renal syndrome) are the most common vasculitic cause of early death.

AREAS COVERED

The diagnostic modalities in the pulmonary vasculitides are reviewed, with a focus on primary systemic vasculitis. A literature search of original research and review articles on pulmonary vasculitides was undertaken using the PubMed database.

EXPERT OPINION

Small-vessel anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis, especially granulomatosis with polyangiitis (Wegener's granulomatosis) are the most frequent causes of pulmonary vasculitis and typically present as nodules, alveolar infiltrates (haemorrhagic or not), cavities or tracheobronchial stenosis. Lung involvement is less common in large-vessel vasculitis when pulmonary vascular abnormalities can be seen. No single test is pathogonomonic and diagnosis requires integration of clinical, laboratory, imaging and histological findings. Treatment follows similar regimens to other vasculitic presentations, with glucocorticoids in conjunction with immunosuppressive agents, and management of intercurrent sepsis and the increased risk of cardiovascular and thromboembolic events. Prompt diagnosis and intensive treatment of pulmonary vasculitis is essential to improve early mortality and long-term outcomes.

Coarctation of the Aorta Associated with Left Subclavian Artery Aneurysm: A Case Report

Aneurysm of the left subclavian artery (LSA) in association with coarctation of the aorta (CoAo) is a rare phenomenon, especially in the younger population. A 19-year-old male patient was admitted for lower extremity varices and diagnosed to have severe CoAo and a 45-mm LSA aneurysm after digital subtraction angiography following detection of nonpalpable lower extremity pulses on physical examination. Corrective surgery was performed from a left posterolateral thoracotomy through the 4th intercostal space, and a discrete ring-like coarctation tissue was observed in the aorta just below the level of the LSA orifice. Complete excision of the coarctation tissue was followed by aortoplasty with a Dacron patch. Additionally, the subclavian aneurysm was completely excised and a 10-mm Dacron tube graft interposition was performed. Prompt diagnosis and surgical treatment in particularly hypertensive patients precludes significant mortality and morbidity following a possible rupture.