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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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2
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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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Kermani TA, Byram K. Isolated Aortitis: Workup and Management. Rheum Dis Clin North Am 2023; 49:523-543. [PMID: 37331731 DOI: 10.1016/j.rdc.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
The finding of aortitis, often incidentally noted on surgical resection, should prompt evaluation for secondary causes including large-vessel vasculitis. In a large proportion of cases, no other inflammatory cause is identified and the diagnosis of clinically isolated aortitis is made. It is unknown whether this entity represents a more localized form of large-vessel vasculitis. The need for immunosuppressive therapy in patients with clinically isolated aortitis remains unclear. Patients with clinically isolated aortitis warrant imaging of the entire aorta at baseline and regular intervals because a significant proportion of patients have or develop abnormalities in other vascular beds.
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Affiliation(s)
- Tanaz A Kermani
- Division of Rheumatology, University of California Los Angeles, 2020 Santa Monica Boulevard, Suite 540, Santa Monica, CA 90404, USA.
| | - Kevin Byram
- Division of Rheumatology and Immunology, Vanderbilt University Medical Center, 1161 21st Avenue South, T3113, MCN, Nashville, TN 37232, USA
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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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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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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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Khan NA, Li D, Newstrom E, Barrios R, Attar M. Hidden in Plain Sight: Discovering Giant Cell Aortopathy During Surgical Mitral Valve Repair. JACC Case Rep 2022; 4:529-532. [PMID: 35573852 PMCID: PMC9091514 DOI: 10.1016/j.jaccas.2022.03.014] [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: 02/22/2022] [Accepted: 03/21/2022] [Indexed: 11/28/2022]
Abstract
Giant cell arteritis (GCA) is an inflammatory cranial and/or extracranial vasculitis. Although cranial GCA is widely recognized, extracranial GCA is underdiagnosed because of its nonspecific and atypical presentations. We report a case of asymptomatic extracranial GCA with ascending thoracic aortopathy discovered incidentally during surgical mitral valve repair. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Najah A. Khan
- Department of Internal Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Daniel Li
- Department of Internal Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | | | - Roberto Barrios
- Department of Pathology, Houston Methodist Hospital, Houston, Texas, USA
| | - Mohammed Attar
- DeBakey Heart and Vascular Institute, Houston Methodist Hospital, Houston, Texas, USA
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Mustafa A, Weilg P, Young L, Anzalone C, Hagau D. Isolated Abdominal Aortitis Following a Urinary Tract Infection. Cureus 2021; 13:e18902. [PMID: 34804739 PMCID: PMC8599397 DOI: 10.7759/cureus.18902] [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] [Accepted: 10/19/2021] [Indexed: 11/05/2022] Open
Abstract
A 49-year-old female with a history of sporadic episodes of scleritis was initially seen by her primary care physician (PCP) due to a two-day history of cramping abdominal pain, new elevated high blood pressure, increased urinary frequency, and urgency. The patient was diagnosed with an acute cystitis supported by a positive urine culture for a pan sensitive Escherichia coli; however, after two courses of antibiotics as an outpatient, her blood pressure (BP) remained markedly elevated, and her abdominal pain got worse which prompted a computed tomography (CT) abdomen and pelvis with contrast revealing inflammatory changes consistent with aortitis. The diagnosis was supported by a magnetic resonance angiography (MRA) which showed wall thickening and enhancement extending for approximately 4.8 cm involving the abdominal aortic wall just prior to the bifurcation. An extensive work up including CTA, US doppler of four-limbs, and fluorodeoxyglucose (FDG)-positron emission tomography (PET) confirmed the isolated abdominal aortitis. After infectious etiologies were ruled out, the patient was started on prednisone 60 mg daily which resulted in marked improvement of her symptoms. After a four-month taper of steroids, the patient had complete resolution of her symptoms, with no signs of recurrence.
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Affiliation(s)
- Ala Mustafa
- Internal Medicine, MercyOne North Iowa Medical Center, Mason City, USA
| | - Pablo Weilg
- Rheumatology, Boston Medical Center, Boston, USA
| | - Larry Young
- Rheumatology, University of Miami, Coral Gables, USA
| | | | - Denisa Hagau
- Cardiology, MercyOne North Iowa Medical Center, Mason City, USA
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Post-operative outcomes of inflammatory thoracic aortitis: a study of 41 patients from a cohort of 1119 surgical cases. Clin Rheumatol 2021; 41:1219-1226. [PMID: 34731347 DOI: 10.1007/s10067-021-05978-z] [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: 09/14/2021] [Revised: 10/23/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022]
Abstract
Aortitis is found in 2-12% of thoracic aortic aneurysm repair/replacement surgeries. Yet little is known about such patients' post-operative outcomes or the role of post-operative corticosteroids. The study was undertaken across three tertiary referral hospitals in Sydney, Australia. Prospectively collected data for all thoracic aortic repair/replacement patients between 2004 and 2018 was accessed from a national surgical registry and analysed. Histopathology records identified cases of inflammatory aortitis which were subclassified as clinically isolated aortitis (CIA), giant cell arteritis (GCA), Takayasu (TAK) or other aortitis. Between-group outcomes were compared utilising logistic and median regression analyses. Between 2004 and 2018, a total of 1119 thoracic aortic surgeries were performed of which 41 (3.7%) were inflammatory aortitis cases (66% CIA, 27% GCA, 5% TAK, 2% other). Eight out of 41 (20%) aortitis patients received post-operative corticosteroids. Compared to non-aortitis patients, the aortitis group was predominantly female (53.7% vs. 28.1%, p < 0.01), was older (mean 70 vs. 62 years, p < 0.01) and had higher prevalence of hypertension (82.9% vs. 67.1%, p = 0.03) and pre-operative immunosuppression (9.8% vs. 1.4%, p < 0.01). There was no difference (p > 0.05) between aortitis and non-aortitis groups for 30-day mortality (7.3% vs 6.5%), significant morbidity (14.6% vs. 22.4%), or infection (9.8% vs. 6.4%). Outcomes were similar for the non-corticosteroid-treated aortitis subgroup. Histologic evidence of inflammatory thoracic aortitis following surgery did not affect post-operative mortality or morbidity. Withholding corticosteroids did not adversely affect patient outcomes. These findings will assist rheumatologists and surgeons in the post-operative management of aortitis.
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Ferfar Y, Morinet S, Espitia O, Agard C, Vautier M, Comarmond C, Desbois AC, Domont F, Resche-Rigon M, Cacoub P, Biard L, Saadoun D. Spectrum and Outcome of Noninfectious Aortitis. J Rheumatol 2021; 48:1583-1588. [PMID: 34210830 DOI: 10.3899/jrheum.201274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the spectrum and long-term outcome of patients with noninfectious aortitis. METHODS We performed a retrospective multicenter study of 353 patients (median age at diagnosis was 62 [IQR 46-71] yrs and 242 [68.6%] patients were women) with noninfectious aortitis. Factors associated with vascular complications were assessed in multivariate analysis. RESULTS We included 136 patients with giant cell arteritis (GCA), 96 with Takayasu arteritis (TA), 73 with clinically isolated aortitis (CIA), and 48 with aortitis secondary to inflammatory diseases (including Behçet disease, relapsing polychondritis, IgG4-related disease, Cogan syndrome, ankylosing spondylitis). After a median follow-up of 52 months, vascular complications were observed in 32.3%, revascularizations in 30% of patients, and death in 7.6%. The 5-year cumulative incidence of vascular complications was 58% (95% CI 41-71), 20% (95% CI 13-29), and 19% (95% CI 11-28) in CIA, GCA, and TA, respectively. In multivariate analysis, male sex (HR 2.10, 95% CI 1.45-3.05, P < 0.0001) and CIA (HR 1.76, 95% CI 1.11-2.81, P = 0.02) were independently associated with vascular complications. CONCLUSION Noninfectious aortitis accounts for significant morbidity and mortality. CIA seems to carry the highest rate of vascular complications.
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Affiliation(s)
- Yasmina Ferfar
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, 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, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
| | - Sarah Morinet
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, 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, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
| | - Olivier Espitia
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, 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, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
| | - Christian Agard
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, 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, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
| | - Mathieu Vautier
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, 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, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
| | - Cloé Comarmond
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, 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, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
| | - Anne Claire Desbois
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, 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, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
| | - Fanny Domont
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, 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, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
| | - Matthieu Resche-Rigon
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, 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, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
| | - Patrice Cacoub
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, 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, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
| | - Lucie Biard
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, 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, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
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11
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Aghayev A, Bay CP, Tedeschi S, Monach PA, Campia U, Gerhard-Herman M, Steigner ML, Mitchell RN, Docken WP, DiCarli M. Clinically isolated aortitis: imaging features and clinical outcomes: comparison with giant cell arteritis and giant cell aortitis. Int J Cardiovasc Imaging 2020; 37:1433-1443. [PMID: 33128155 DOI: 10.1007/s10554-020-02087-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/23/2020] [Indexed: 10/23/2022]
Abstract
(1) describe imaging features of CIA, (2) compare dilation rate and wall thickening of aortic aneurysms in patients with CIA versus those with giant cell arteritis/aortitis (GCA), (3) present clinical outcomes of CIA patients. Retrospective search of electronic records from 2004 to 2018 yielded 71 patients, 52 of whom were female, with a mean age of 67.5 ± 9.0 years old, with a new clinical diagnosis of cranial or extracranial GCA (GCA group), and giant cell aortitis revealed by the aortic biopsy (CIA group). Comparisons between groups were conducted using the Wilcoxon rank-sum and Fisher's exact tests. Survival from the date of initial diagnosis to the end of data collection was compared between the two groups through a log-rank test. CIA patients (n = 23; 32%) presented with cardiovascular symptoms, and none had systemic inflammatory symptoms. Inflammatory markers were significantly higher among GCA patients than among CIA patients (p < 0.0001). The CIA group demonstrated thoracic aortic aneurysms without wall thickening. None of the GCA patients (n = 48; 68%) had aneurysmal dilation in the aorta at the time of diagnosis. None of the four CIA patients had FDG uptake in the aorta, while nine out of 13 GCA patients had FDG uptake in the vessels. There was no statistically significant difference in the survival between the two groups (p = 0.12). CIA patients presented with cardiovascular symptoms and was characterized by aneurysm of the aorta without the involvement of the infrarenal aortic segment. The role of FDG-PET/CT in CIA is less certain, though none of the patients in this cohort had FDG uptake in the vessels.
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Affiliation(s)
- Ayaz Aghayev
- Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | - Camden P Bay
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sara Tedeschi
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul A Monach
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Umberto Campia
- Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Marie Gerhard-Herman
- Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael L Steigner
- Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Richard N Mitchell
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - William P Docken
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Marcelo DiCarli
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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12
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Shah R, Pulton D, Wenger RK, Ha B, Feinman JW, Patel S, Lau C, Rong LQ, Weiss SJ, Augoustides JG, Daubenspeck D, Chaney MA. Aortic Dissection During Cardiac Surgery. J Cardiothorac Vasc Anesth 2020; 35:323-331. [PMID: 32928651 DOI: 10.1053/j.jvca.2020.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Ronak Shah
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Danielle Pulton
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Robert K Wenger
- Division of Cardiac Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Bao Ha
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jared W Feinman
- Division of Cardiac Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Saumil Patel
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Christopher Lau
- Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Lisa Q Rong
- Department of Anesthesiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Stuart J Weiss
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John G Augoustides
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Danisa Daubenspeck
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL
| | - Mark A Chaney
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL.
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13
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[The current place of non-invasive large-vessel imaging in the diagnosis and follow-up of giant cell arteritis]. Rev Med Interne 2020; 41:756-768. [PMID: 32674899 DOI: 10.1016/j.revmed.2020.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/28/2020] [Accepted: 06/01/2020] [Indexed: 11/22/2022]
Abstract
Large vessel involvement in giant cell arteritis has long been described, although its right frequency and potential prognostic value have only been highlighted for two decades. Large vessel involvement not only is associated with a high incidence of late aortic aneurysms, but also might cause greater resistance to glucocorticoids and longer treatment duration, as well as worse late cardiovascular outcomes. These data were brought to our attention, thanks to substantial progress recently made in large vessel imaging. This relies on four single, often complementary, approaches of varying availability: colour Doppler ultrasound, contrast-enhanced computed tomography with angiography and, magnetic resonance imaging, which all demonstrate homogeneous circumferential wall thickening and describe structural changes; 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET/CT), which depicts wall inflammation and assesses many vascular territories in the same examination. In addition, integrated head-and-neck PET/CT can accurately and reliably diagnose cranial arteritis. All four procedures exhibit high diagnostic performance for a large vessel arteritis diagnosis so that the choice is left to the physician, depending on local practices and accessibility; the most important is to carry out the chosen modality without delay to avoid false or equivocal results, due to early vascular oedema changes as a result of high dose glucocorticoid treatment. Yet, ultrasound study of the superficial cranial and subclavian/axillary arteries remains a first line assessment aimed at strengthening and expediting the clinical diagnosis as well as raising suspicion of large-vessel involvement. In treated patients, vascular imaging results are poorly correlated with clinical-biological controlled disease so that it is strongly recommended not to renew imaging studies unless a large vessel relapse or complication is suspected. On the other hand, a structural monitoring of aorta following giant cell arteritis is mandatory, but uncertainties remain regarding the best procedural approach, timing of first control and spacing between controls. Individuals at greater risk of developing aortic complication, e.g. those with classic risk factors for aneurysm and/or visualised aortitis, should be monitored more closely.
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14
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Quimson L, Mayer A, Capponi S, Rea B, Rhee RL. Comparison of Aortitis Versus Noninflammatory Aortic Aneurysms Among Patients Who Undergo Open Aortic Aneurysm Repair. Arthritis Rheumatol 2020; 72:1154-1159. [PMID: 32067388 DOI: 10.1002/art.41233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 02/13/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Distinguishing aortitis-induced aneurysms from noninflammatory aortic aneurysms is difficult and often incidentally diagnosed on histologic examination after surgical repair. This study was undertaken to examine surgically diagnosed aortitis and identify patient characteristics and imaging findings associated with the disease. METHODS In this case-control study, cases had newly diagnosed, biopsy-proven noninfectious aortitis after open thoracic aortic aneurysm surgical repair. Five controls were matched with cases for year of surgery and lacked significant inflammation on surgical pathology analysis. Data on comorbidities, demographic characteristics, and laboratory and imaging abnormalities prior to surgery were collected. Associations between exposures and outcomes were evaluated using conditional logistic regression. Backward stepwise logistic regression was used to determine factors independently associated with aortitis. Odds ratios (ORs) with 95%confidence intervals (95%CIs) were calculated. RESULTS The study included 262 patients (43 patients with aortitis and 219 controls). Patients with aortitis were older at the time of surgery, predominantly female, and less likely to have a history of coronary artery disease (CAD). Multivariable analysis revealed that aortitis was independently associated with an older age at the time of surgery (OR 1.08 [95%CI 1.03-1.13], P < 0.01), female sex (OR 2.36 [95%CI 1.01-5.51], P = 0.04), absence of CAD (OR 6.92 [95%CI 2.14-22.34], P = 0.04), a larger aneurysm diameter (OR 1.74 [95%CI 1.02-2.98], P = 0.04), and arterial wall thickening on imaging (OR 56.93 [95%CI 4.31-752.33], P < 0.01). CONCLUSION Among patients who undergo open surgical repair of an aortic aneurysm, elderly women with no history of CAD who have evidence of other aortic or arterial wall thickening on imaging are more likely to have histologic evidence of aortitis. Patients with these characteristics may benefit from further rheumatologic evaluation.
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Affiliation(s)
- Laarni Quimson
- Hospital of the University of Pennsylvania, Philadelphia
| | - Adam Mayer
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Sarah Capponi
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Bryan Rea
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Rennie L Rhee
- Hospital of the University of Pennsylvania, Philadelphia
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15
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Abstract
Isolated noninfectious ascending aortitis (I-NIAA) is increasingly diagnosed at histopathologic review after resection of an ascending aortic aneurysm. PubMed was searched using the term aortitis; publications addressing the issue were reviewed, and reference lists of selected articles were also reviewed. Eleven major studies investigated the causes of an ascending aortic aneurysm or dissection requiring surgical repair: the prevalence of noninfectious aortitis ranged from 2% to 12%. Among 4 studies of lesions limited to the ascending aorta, 47% to 81% of cases with noninfectious aortitis were I-NIAA, more frequent than Takayasu arteritis or giant cell arteritis. Because of its subclinical nature and the lack of "syndromal signs" as in Takayasu arteritis or giant cell arteritis, I-NIAA is difficult to diagnose before complications occur, such as an aortic aneurysm or dissection. Therefore, surgical specimens of dissected aortic tissue should always be submitted for pathologic review. Diagnostic certainty requires the combination of a standardized histopathologic and clinical investigation. This review summarizes the current knowledge on I-NIAA, followed by a suggested approach to diagnosis, management, and follow-up. An illustrative case of an uncommon presentation is also presented. More follow-up studies on I-NIAA are needed, and diagnosis and follow-up of I-NIAA may benefit from the development of diagnostic biomarkers.
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16
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Clifford AH, Arafat A, Idrees JJ, Roselli EE, Tan CD, Rodriguez ER, Svensson LG, Blackstone E, Johnston D, Pettersson G, Soltesz E, Hoffman GS. Outcomes Among 196 Patients With Noninfectious Proximal Aortitis. Arthritis Rheumatol 2019; 71:2112-2120. [DOI: 10.1002/art.40855] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 11/27/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Alison H. Clifford
- Cleveland Clinic Foundation, Cleveland, Ohio, and University of Alberta Edmonton Alberta Canada
| | - Amr Arafat
- Cleveland Clinic Foundation, Cleveland, Ohio, and Tanta University Tanta Egypt
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17
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Goldhar HA, Walker KM, Abdelrazek M, Belanger EC, Boodhwani M, Milman N. Characteristics and outcomes in a prospective cohort of patients with histologically diagnosed aortitis. Rheumatol Adv Pract 2019; 3:rky051. [PMID: 31431987 PMCID: PMC6649911 DOI: 10.1093/rap/rky051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/10/2018] [Indexed: 11/12/2022] Open
Abstract
Objectives Our aim was to evaluate characteristics and prospective adverse aortic outcomes in a cohort of patients with non-infectious histological aortitis. Methods Patients with histological aortitis, diagnosed at the Ottawa Hospital after surgical repair of thoracic aortic aneurysms or dissections, consented to enrolment in a prospective observational cohort. Patients were assessed for an underlying inflammatory condition and followed prospectively with periodic clinical, laboratory and radiographic assessments. Aortic outcomes during follow-up included significant events, defined as new thoracic or abdominal aortic aneurysms, dissections, ruptures or other complications requiring aortic intervention, in addition to aortic branch ectasias, aneurysms and stenosis. Results Sixteen patients with histological aortitis from surgical procedures performed between 2010 and 2017 were included; nine had idiopathic and seven had secondary aortitis. Idiopathic patients were more likely to have smoked (100 vs 43%, P = 0.02) and had more associated arch or descending aortic aneurysms on pre-operative baseline imaging compared with secondary aortitis (6 vs 0, P = 0.01). At the median 3.6 years of follow-up, eight patients (50%) had 10 significant aortic events. The incidence of aortic dissection was higher in the first year post-surgery, compared with subsequent years, whereas incident aneurysms occurred throughout follow-up. Elevated inflammatory markers during follow-up trended towards association with accumulation of severe aortic damage. Conclusion This is the first reported prospective study in patients with histological aortitis. Within the limitations of a small cohort, we report a high incidence of aortic complications. Studies with a larger sample size and longer follow-up are needed to corroborate these findings.
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Affiliation(s)
- Hart A Goldhar
- Department of Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Kyle M Walker
- Division of Rheumatology, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Mohamed Abdelrazek
- Department of Medical Imaging, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Eric C Belanger
- Department of Pathology and Laboratory Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Munir Boodhwani
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Nataliya Milman
- Division of Rheumatology, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Clinical Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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18
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Abstract
Patients with aortitis often present with nonspecific constitutional symptoms. Due to the fact that aortitis is associated with inflammatory or infectious courses, patients may manifest fever or fever of unknown origin. Such clinical characteristics of aortitis are unavoidably brought about diagnostic dilemmas and might lead to a series of unnecessary work-ups and maltreatment. Therefore, it is important for the clinical physicians and surgeons to understand aortitis presenting with fever of unknown origin to avoid delayed diagnosis and treatment. In this article, clinical and pathological features of aortitis (giant cell arteritis, Takayasu arteritis and infective aortitis, etc.) with fever of unknown origin are described and the differential diagnosis and management policy are discussed.
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Affiliation(s)
- Shi-Min Yuan
- Department of Cardiothoracic Surgery, Teaching Hospital, Fujian Medical University, Putian, Fujian, China
| | - Hong Lin
- Department of Cardiology, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian, Fujian, China
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Pulmonary Artery Compression and Invasion by a Ruptured Giant Thoracic Aortic Aneurysm: A Rare Presentation. ACTA ACUST UNITED AC 2018; 2:201-206. [PMID: 30370383 PMCID: PMC6200667 DOI: 10.1016/j.case.2018.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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20
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Diagnosis and differential diagnosis of large-vessel vasculitides. Rheumatol Int 2018; 39:169-185. [PMID: 30221327 DOI: 10.1007/s00296-018-4157-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 09/10/2018] [Indexed: 12/13/2022]
Abstract
There are no universally accepted diagnostic criteria for large-vessel vasculitides (LVV), including giant cell arteritis (GCA) and Takayasu arteritis (TAK). Currently, available classification criteria cannot be used for the diagnosis of GCA and TAK. Early diagnosis of these two diseases is quite challenging in clinical practice and may be accomplished only by combining the patient symptoms, physical examination findings, blood test results, imaging findings, and biopsy results, if available. Awareness of red flags which lead the clinician to investigate TAK in a young patient with persistent systemic inflammation is helpful for the early diagnosis. It should be noted that clinical presentation may be highly variable in a subgroup of GCA patients with predominant large-vessel involvement (LVI) and without prominent cranial symptoms. Imaging modalities are especially helpful for the diagnosis of this subgroup. Differential diagnosis between older patients with TAK and this subgroup of GCA patients presenting with LVI may be difficult. Various pathologies may mimic LVV either by causing systemic inflammation and constitutional symptoms, or by causing lumen narrowing with or without aneurysm formation in the aorta and its branches. Differential diagnosis of aortitis is crucial. Infectious aortitis including mycotic aneurysms due to septicemia or endocarditis, as well as causes such as syphilis and mycobacterial infections should always be excluded. On the other hand, the presence of non-infectious aortitis is not unique for TAK and GCA. It should be noted that aortitis, other large-vessel involvement or both, may occasionally be seen in various other autoimmune pathologies including ANCA-positive vasculitides, Behçet's disease, ankylosing spondylitis, sarcoidosis, and Sjögren's syndrome. Besides, aortitis may be idiopathic and isolated. Atherosclerosis should always be considered in the differential diagnosis of LVV. Other pathologies which may mimic LVV include, but not limited to, congenital causes of aortic coarctation and middle aortic syndrome, immunoglobulin G4-related disease, and hereditary disorders of connective tissue such as Marfan syndrome and Ehler-Danlos syndrome.
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21
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Kebed DT, Bois JP, Connolly HM, Scott CG, Bowen JM, Warrington KJ, Makol A, Greason KL, Schaff HV, Anavekar NS. Spectrum of Aortic Disease in the Giant Cell Arteritis Population. Am J Cardiol 2018; 121:501-508. [PMID: 29291886 DOI: 10.1016/j.amjcard.2017.11.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/01/2017] [Accepted: 11/07/2017] [Indexed: 01/12/2023]
Abstract
We report the spectrum of aortic involvement in patients with giant cell arteritis (GCA) following review of medical records of 4,006 patients including those with imaging studies. A total of 1,450 patients (36%) had a confirmed diagnosis of GCA. Of these, 974 had aortic imaging. Of the 974 patients with imaging, 435 (45%) had an identified aortopathy. The most common aortopathy was aneurysm/dilation (69%). Overall, an annual aneurysmal growth rate of 1.5 mm/y was calculated. In patients with aneurysm/dilation, aortic dissection occurred in 18 patients (6%), and these patients had a significantly higher aneurysmal growth rate compared with those without dissection (4.5 vs 1.4 mm/y, p = 0.005). The median size of the aorta at the time of dissection was 51 mm, with 7 (39%) occurring with a maximal aortic aneurysm/dilation <50 mm. In conclusion, our findings indicate higher aneurysmal growth rate in GCA compared with that reported for degenerative aortic disease. Moreover, patients who develop dissection had a significantly higher growth rate than those without dissection with over a third of these patients suffering dissection at a caliber <50 mm.
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Affiliation(s)
- Daniel T Kebed
- Rush University Medical Center, Department of Internal Medicine, Chicago, Illinois
| | - John P Bois
- Mayo Clinic Rochester, Division of Cardiovascular Disease, Rochester, Minnesota
| | - Heidi M Connolly
- Mayo Clinic Rochester, Division of Cardiovascular Disease, Rochester, Minnesota
| | - Christopher G Scott
- Mayo Clinic Rochester, Department of Biomedical Statistics and Informatics, Rochester, Minnesota
| | - Juan M Bowen
- Mayo Clinic Rochester, Division of Primary Care Internal Medicine, Rochester, Minnesota
| | | | - Ashima Makol
- Mayo Clinic Rochester, Division of Rheumatogy, Rochester, Minnesota
| | - Kevin L Greason
- Mayo Clinic Rochester, Division of Cardiovascular Surgery, Rochester, Minnesota
| | - Hartzell V Schaff
- Mayo Clinic Rochester, Division of Cardiovascular Surgery, Rochester, Minnesota
| | - Nandan S Anavekar
- Mayo Clinic Rochester, Division of Cardiovascular Disease, Rochester, Minnesota.
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22
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Impact of Medical Therapy on Late Morbidity and Mortality After Aortic Aneurysm Repair for Aortitis. Ann Thorac Surg 2018; 105:1731-1736. [PMID: 29408240 DOI: 10.1016/j.athoracsur.2018.01.009] [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] [Received: 09/08/2017] [Revised: 12/08/2017] [Accepted: 01/03/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Patients with active aortitis who undergo repair of ascending aortic aneurysms have an increased risk of late reoperation and decreased late survival. We aimed to determine the reasons for these poor outcomes and the influence of medical management. METHODS We reviewed records of 186 patients (median age 73.9 years; 120 women) with noninfectious aortitis after elective ascending aortic aneurysm repair (January 1955 through December 2012). Landmark analysis was used to compare outcomes in patients with isolated aortitis versus with systemic sequelae of aortitis along with outcomes of treatment with glucocorticoids. RESULTS At 15 years, the overall mortality was 88.3%; at 10 years, the overall reoperation rate was 28.2%. Long-term mortality increased with older age at surgery (hazard ratio [HR] 1.62, 95% confidence interval [CI]: 1.25 to 2.11, p < 0.001), coronary artery disease (HR 1.94, 95% CI: 1.25 to 3.01, p = 0.003), peripheral vascular disease (HR 1.79, 95% CI: 1.09 to 2.94, p = 0.02), and preoperative suspicion of aortitis (HR 4.90, 95% CI: 1.96 to 12.26, p < 0.001). Increased reoperation rate was associated with coronary artery disease (HR 2.69, 95% CI: 1.17 to 6.17, p = 0.02) and peripheral vascular disease (HR 3.92, 95% CI: 1.71 to 8.94, p = 0.001). Among patients free of reoperation at 6 months, systemic sequelae of aortitis were found to be significant, with an unadjusted hazard ratio of 3.59 (95% CI: 1.40 to 9.18, p = 0.008). Treatment with glucocorticoids was not associated with subsequent mortality or reoperation. CONCLUSIONS The development of systemic illness secondary to aortitis was associated with increased risk of late aortic reoperations. However, glucocorticoid treatment of noninfectious aortitis did not clearly influence survival or need for reoperation.
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23
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Hjuler KF, Gormsen LC, Iversen L. Using FDG-PET/CT to Detect Vascular Inflammation in Patients with Psoriasis: Where to Look? And for What?? J Invest Dermatol 2017; 137:2236-2237. [DOI: 10.1016/j.jid.2017.05.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 05/18/2017] [Indexed: 10/19/2022]
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24
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Skeik N, Ostertag-Hill CA, Garberich RF, Alden PB, Alexander JQ, Cragg AH, Manunga JM, Stephenson EJ, Titus JM, Sullivan TM. Diagnosis, Management, and Outcome of Aortitis at a Single Center. Vasc Endovascular Surg 2017; 51:470-479. [PMID: 28859604 DOI: 10.1177/1538574417704296] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Aortitis is a rare condition with inflammatory or infectious etiology that can be difficult to diagnose due to the highly variable clinical presentation and nonspecific symptoms. However, current literature on the diagnosis, management, and prognosis of aortitis is extremely scarce. METHODS We retrospectively reviewed all patients' charts who were diagnosed with giant cell arteritis, Takayasu arteritis, or noninfectious aortitis presenting at a single center between January 1, 2009, and April 17, 2015. Data collected included demographics, medical history, comorbidities, laboratory and imaging data, management, and outcome. RESULTS Among the included 15 patients presenting with aortitis at our center, 53% were diagnosed with Takayasu arteritis, 33% with idiopathic inflammatory aortitis, and 13% with giant cell arteritis. All patients received steroid treatment, 67% received adjunctive immunosuppressants or immunomodulators, and 33% underwent interventional procedures. Based on clinical presentation and laboratory and imaging findings at the last follow-up visit for each patient, 67% showed improvement, 27% had no change in disease activity, and 7% had a progression of the disease. CONCLUSIONS Takayasu arteritis was found to be more common than idiopathic inflammatory aortitis and giant cell arteritis among our 15 cases diagnosed with aortitis. All patients received medical therapy and 33% received interventional procedures, leading to 67% improvement of disease activity or related complications. This article also offers a comprehensive review of the diagnosis, management, and outcome of aortitis, supplementing the very limited literature on this disease.
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Affiliation(s)
- Nedaa Skeik
- 1 Vascular Medicine, Minneapolis Heart Institute, Minneapolis, MN, USA
| | | | - Ross F Garberich
- 2 Minneapolis Heart Institute Research Foundation, Minneapolis, MN, USA
| | - Peter B Alden
- 3 Vascular Surgery, Minneapolis Heart Institute, Minneapolis, MN, USA
| | - Jason Q Alexander
- 3 Vascular Surgery, Minneapolis Heart Institute, Minneapolis, MN, USA
| | - Andrew H Cragg
- 3 Vascular Surgery, Minneapolis Heart Institute, Minneapolis, MN, USA
| | - Jesse M Manunga
- 3 Vascular Surgery, Minneapolis Heart Institute, Minneapolis, MN, USA
| | | | - Jessica M Titus
- 3 Vascular Surgery, Minneapolis Heart Institute, Minneapolis, MN, USA
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25
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Murzin DL, Belanger EC, Veinot JP, Milman N. A case series of surgically diagnosed idiopathic aortitis in a Canadian centre: a retrospective study. CMAJ Open 2017. [PMID: 28641275 PMCID: PMC5963355 DOI: 10.9778/cmajo.20160094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Idiopathic aortitis became recognized relatively recently, and the body of knowledge concerning this condition is scarce. We aimed to determine the frequency of idiopathic aortitis in aortic specimens, the clinical, laboratory and radiologic characteristics at diagnosis and during follow-up, and the approach to investigation, treatment and monitoring taken by the treating physicians. METHODS We identified cases of aortitis diagnosed on pathological specimens of the aorta between Jan. 1, 2003, and July 31, 2013, at The Ottawa Hospital by reviewing the hospital's pathology database. Charts of identified patients were reviewed, and data on patient demographic characteristics, clinical features, laboratory and imaging tests, treatment and outcomes were analyzed. RESULTS A total of 684 aortic specimens were analyzed during the study period; 47 cases of aortitis were identified, 32 of which were idiopathic. Twenty-one patients (66%) had complete imaging of branch vessels at baseline, 16 (76%) of whom had additional aortic or branch vessel lesions. Twelve patients (38%) received corticosteroids postoperatively. Over a mean follow-up period of 47.5 months, among the 12 patients (38%) who had complete imaging of branch vessels at least once, new aortic or branch lesions were diagnosed in 5 (42%); 3/32 patients (9%) required additional vascular surgery; and a new systemic condition was diagnosed in 2/32 (6%). INTERPRETATION Idiopathic aortitis is commonly discovered incidentally on examination of the pathological specimen following ascending aortic aneurysm repair. No guidelines exist for the investigation, treatment and follow-up of this condition, resulting in great variability of practice. Good-quality prospective studies are needed to address the many unanswered clinical questions regarding idiopathic aortitis and to allow formulation of more definitive recommendations.
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Affiliation(s)
- Diane L Murzin
- Affiliations: Division of Rheumatology (Murzin, Milman), Department of Medicine, University of Ottawa; Department of Pathology and Laboratory Medicine (Belanger, Veinot), The Ottawa Hospital; Department of Clinical Epidemiology (Milman), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Eric C Belanger
- Affiliations: Division of Rheumatology (Murzin, Milman), Department of Medicine, University of Ottawa; Department of Pathology and Laboratory Medicine (Belanger, Veinot), The Ottawa Hospital; Department of Clinical Epidemiology (Milman), Ottawa Hospital Research Institute, Ottawa, Ont
| | - John P Veinot
- Affiliations: Division of Rheumatology (Murzin, Milman), Department of Medicine, University of Ottawa; Department of Pathology and Laboratory Medicine (Belanger, Veinot), The Ottawa Hospital; Department of Clinical Epidemiology (Milman), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Nataliya Milman
- Affiliations: Division of Rheumatology (Murzin, Milman), Department of Medicine, University of Ottawa; Department of Pathology and Laboratory Medicine (Belanger, Veinot), The Ottawa Hospital; Department of Clinical Epidemiology (Milman), Ottawa Hospital Research Institute, Ottawa, Ont
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26
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Procop GW, Eng C, Clifford A, Villa-Forte A, Calabrese LH, Roselli E, Svensson L, Johnston D, Pettersson G, Soltesz E, Lystad L, Perry JD, Blandford A, Wilson DA, Hoffman GS. Varicella Zoster Virus and Large Vessel Vasculitis, the Absence of an Association. Pathog Immun 2017; 2:228-238. [PMID: 28758156 PMCID: PMC5531613 DOI: 10.20411/pai.v2i2.196] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: It is controversial whether microorganisms play a role in the pathogenesis of large and medium vessel vasculitides (eg, giant cell arteritis [GCA], Takayasu arteritis [TAK] and focal idiopathic aortitis [FIA]). Recent studies have reported the presence of Varicella Zoster Virus (VZV) within formalin-fixed, paraffin-embedded temporal arteries and aortas of about three-quarters or more of patients with these conditions, and in a minority of controls. In a prospective study, we sought to confirm these findings using DNA extracted from vessels that were harvested under surgically aseptic conditions and snap frozen. Methods and Results: DNA samples extracted from 11 surgically sterile temporal arteries and 31 surgically sterile thoracic aortas were used in an attempt to identify the vessel-associated VZV genome. Two different validated PCR methods were used. Thirty-one thoracic aorta aneurysm specimens included biopsies from 8 patients with GCA, 2 from patients with TAK, 6 from patients with FIA, and 15 from patients without vasculitis, who had non-inflammatory aneurysms. Eleven temporal artery biopsies were collected from 5 patients with GCA and 6 controls. The presence of VZV was not identified in either the specimens from patients with large vessel vasculitis or from the controls. Conclusions: Using surgically sterile snap-frozen specimens, we were unable to confirm recent reports of the presence of VZV in either aortas or temporal arteries from patients with large vessel vasculitis or controls.
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Affiliation(s)
- Gary W Procop
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Charis Eng
- Genomic Medicine Institute, Lerner Research Institute, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Alison Clifford
- Center for Vasculitis Care and Research, Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio.,Division of Rheumatology, University of Alberta, Canada
| | - Alexandra Villa-Forte
- Center for Vasculitis Care and Research, Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio
| | - Leonard H Calabrese
- Center for Vasculitis Care and Research, Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio
| | - Eric Roselli
- Heart & Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lars Svensson
- Heart & Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | | | | | - Edward Soltesz
- Heart & Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lisa Lystad
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | | | | | - Deborah A Wilson
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Gary S Hoffman
- Center for Vasculitis Care and Research, Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio
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27
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Cinar I, Wang H, Stone JR. Clinically isolated aortitis: pitfalls, progress, and possibilities. Cardiovasc Pathol 2017; 29:23-32. [PMID: 28500877 DOI: 10.1016/j.carpath.2017.04.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 04/20/2017] [Accepted: 04/20/2017] [Indexed: 12/12/2022] Open
Abstract
Non-infectious aortitis may be caused by several distinct systemic rheumatologic diseases. In some patients, aortitis is identified either pathologically or radiologically in the absence of clinical evidence of a systemic vasculitis. By consensus nomenclature, such cases are referred to as clinically isolated aortitis (CIA). Some systemic disorders may initially present as CIA including giant cell arteritis (GCA), IgG4-related disease, infectious aortitis, and granulomatosis with polyangiitis. CIA most commonly occurs in women of European descent over the age of 50 and, thus, mirrors the gender, age, and geographic distribution of GCA. CIA most often demonstrates a granulomatous/giant cell pattern of inflammation (GPI), and CIA-GPI is pathologically indistinguishable from aortitis due to GCA. In many cases, CIA may be a manifestation of extracranial GCA. CIA is being identified both pathologically in resected aortic tissue and radiologically by computed tomography scanning, magnetic resonance imaging, and fluorodeoxyglucose positron emission tomography. However, there appears to be significant differences between pathologically defined CIA and radiologically defined CIA. Multiple studies have shown that patients with CIA are at increased risk for subsequent aortic events (new aneurysms or dissections) and thus it is recommended to monitor these patients with periodic aortic imaging. While the data is currently limited, there is increasing evidence that at least some patients with CIA may benefit from immunosuppressive therapy.
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Affiliation(s)
- Ilkay Cinar
- Department of Pathology, Prof. Dr. A. Ilhan Ozdemir Research Hospital, Giresun University, Giresun, Turkey
| | - He Wang
- Department of Pathology and Laboratory Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - James R Stone
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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28
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Yoon J, Gruboy IPC, Zaid A, Salil SG, Connolly M, Aronow WS, Elozomor W, Zuberi J. Isolated idiopathic aortitis with an unusually thickened aortic wall: case report. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:428. [PMID: 27942519 DOI: 10.21037/atm.2016.11.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Aortitis includes a broad range of disorders involving inflammation of the aorta. While most forms of aortitis can be linked to a specific cause, patients with idiopathic aortitis (IDA), are asymptomatic and usually diagnosed after surgical removal. The specific pathophysiology is not well understood, but can be strongly associated with tobacco smoking, young age at presentation, and family history of aortic aneurysm. Wall thickening is the most common physical characteristic of aortitis, and the inflammation can affect any layer of the aorta. The normal wall thickness of the aorta is less than 4 mm and can be as thick as 9 mm. Few studies document a correlation between wall thickness and the severity of aortitis. This paper presents a unique case of severe aortic aneurysm associated with an abnormal thickening of the ascending aorta.
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Affiliation(s)
- John Yoon
- Department of Cardiothoracic Surgery, New York Medical College at Saint Joseph's, Paterson, NJ, USA
| | - Irina Pa-C Gruboy
- Department of Cardiothoracic Surgery, New York Medical College at Saint Joseph's, Paterson, NJ, USA
| | - Altheeb Zaid
- Department of Cardiovascular Medicine, New York Medical College at Saint Joseph's, Paterson, NJ, USA
| | - Shah G Salil
- Department of Cardiothoracic Surgery, Aria Jefferson Health/Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - Mark Connolly
- Department of Cardiothoracic Surgery, New York Medical College at Saint Joseph's, Paterson, NJ, USA
| | - Wilbert S Aronow
- Department of Medicine, Division of Cardiology, New York Medical College, Valhalla, NY, USA
| | - Walid Elozomor
- Department of Cardiothoracic Surgery, New York Medical College at Saint Joseph's, Paterson, NJ, USA
| | - Jamshed Zuberi
- Department of Cardiothoracic Surgery, New York Medical College at Saint Joseph's, Paterson, NJ, USA
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Abstract
Various imaging modalities, including color duplex ultrasonography, CT angiography, magnetic resonance angiography, and PET, are emerging as important aids to the diagnosis, staging, evaluation of disease activity and response to treatment in systemic vasculitis. Although large-vessel vasculitis is the main target of imaging, refinement and increasing accuracy of imaging modalities are also providing useful information in the evaluation of medium-vessel and small-vessel vasculitis.
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30
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Lee K, Shah NP, Christenson ES, Zakaria S, Okwuosa I. Acute decompensated heart failure as the initial presentation of isolated aortitis. Future Cardiol 2016; 12:467-70. [PMID: 27291815 DOI: 10.2217/fca-2016-0005] [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: 11/21/2022] Open
Abstract
Decompensated heart failure affects 5 million Americans and nearly 15 million individuals worldwide. Heart failure can be attributed to numerous etiologies, with autoimmune conditions representing a rare category of acute decompensations. Here, we report of case of a 66-year-old woman who presented with acute decompensated heart failure as a result of a rare vasculitis known as idiopathic aortitis. In addition to describing the case, we highlight the importance of proper ascending aorta evaluation in patients presenting with new onset heart failure, especially in the setting of aortic regurgitation. We use this case to discuss the entity of idiopathic aortitis, and review the literature on its clinical manifestations and long-term management.
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Affiliation(s)
- Kimberley Lee
- Department of Medicine, Johns Hopkins University School of Medicine, 4940 Eastern Avenue, Baltimore, MD 21224, USA
| | - Nishant P Shah
- Department of Medicine, Johns Hopkins University School of Medicine, 4940 Eastern Avenue, Baltimore, MD 21224, USA
| | - Eric S Christenson
- Department of Medicine, Johns Hopkins University School of Medicine, 4940 Eastern Avenue, Baltimore, MD 21224, USA
| | - Sammy Zakaria
- Department of Medicine, Johns Hopkins University School of Medicine, 4940 Eastern Avenue, Baltimore, MD 21224, USA
| | - Ike Okwuosa
- Department of Medicine, Johns Hopkins University School of Medicine, 4940 Eastern Avenue, Baltimore, MD 21224, USA
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31
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Espitia O, Samson M, Le Gallou T, Connault J, Landron C, Lavigne C, Belizna C, Magnant J, de Moreuil C, Roblot P, Maillot F, Diot E, Jégo P, Durant C, Masseau A, Brisseau JM, Pottier P, Espitia-Thibault A, Santos AD, Perrin F, Artifoni M, Néel A, Graveleau J, Moreau P, Maisonneuve H, Fau G, Serfaty JM, Hamidou M, Agard C. Comparison of idiopathic (isolated) aortitis and giant cell arteritis-related aortitis. A French retrospective multicenter study of 117 patients. Autoimmun Rev 2016; 15:571-6. [PMID: 26903476 DOI: 10.1016/j.autrev.2016.02.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 02/14/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The aim of the study was to compare clinical/imaging findings and outcome in patients with idiopathic (isolated aortitis, IA) and with giant cell arteritis (GCA)-related aortitis. METHODS Patients from 11 French internal medicine departments were retrospectively included. Aortitis was defined by aortic wall thickening >2mm and/or an aortic aneurysm on CT-scan, associated to inflammatory syndrome. Patients with GCA had at least 3 ACR criteria. Aortic events (aneurysm, dissection, aortic surgeries) were reported, and free of aortic events-survival were compared. RESULTS Among 191 patients with non-infectious aortitis, 73 with GCA and 44 with IA were included. Patients with IA were younger (65 vs 70 years, p=0.003) and comprised more past/current smokers (43 vs 15%, p=0.0007). Aortic aneurisms were more frequent (38% vs 20%, p=0.03), and aortic wall thickening was more pronounced in IA. During follow-up (median=34 months), subsequent development of aortic aneurysm was significantly lower in GCA when compared to IA (p=0.009). GCA patients required significantly less aortic surgery during follow-up than IA patients (p=0.02). Mean age, sex ratio, inflammatory parameters, and free of aortic aneurism survival were equivalent in patients with IA ≥ 60 years when compared to patients with GCA-related aortitis. CONCLUSIONS IA is more severe than aortitis related to GCA, with higher proportions of aortic aneurism at diagnosis and during follow-up. IA is a heterogeneous disease and its prognosis is worse in younger patients <60 years. Most patients with IA ≥ 60 years share many features with GCA-related aortitis.
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Affiliation(s)
- Olivier Espitia
- Department of Diagnostic Cardio-vascular Imaging, University hospital of Nantes, Nantes, France
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, University Hospital of Dijon, Dijon, France
| | - Thomas Le Gallou
- Department of Internal Medicine, University Hospital of Rennes, Rennes, France
| | - Jérôme Connault
- Department of Diagnostic Cardio-vascular Imaging, University hospital of Nantes, Nantes, France
| | - Cedric Landron
- Department of Internal Medicine, University Hospital of Poitiers, Poitiers, France
| | - Christian Lavigne
- Department of Internal Medicine, University Hospital of Angers, Angers, France
| | - Cristina Belizna
- Department of Internal Medicine, University Hospital of Angers, Angers, France
| | - Julie Magnant
- Department of Internal Medicine, CHRU of Tours, Tours, France
| | - Claire de Moreuil
- Department of Internal Medicine, University Hospital of Brest, Brest, France
| | - Pascal Roblot
- Department of Internal Medicine, University Hospital of Poitiers, Poitiers, France
| | | | - Elisabeth Diot
- Department of Internal Medicine, CHRU of Tours, Tours, France
| | - Patrick Jégo
- Department of Internal Medicine, University Hospital of Rennes, Rennes, France
| | - Cécile Durant
- Department of Diagnostic Cardio-vascular Imaging, University hospital of Nantes, Nantes, France
| | - A Masseau
- Department of Diagnostic Cardio-vascular Imaging, University hospital of Nantes, Nantes, France
| | - Jean-Marie Brisseau
- Department of Diagnostic Cardio-vascular Imaging, University hospital of Nantes, Nantes, France
| | - Pierre Pottier
- Department of Diagnostic Cardio-vascular Imaging, University hospital of Nantes, Nantes, France
| | | | | | - François Perrin
- Department of Diagnostic Cardio-vascular Imaging, University hospital of Nantes, Nantes, France
| | - Mathieu Artifoni
- Department of Diagnostic Cardio-vascular Imaging, University hospital of Nantes, Nantes, France
| | - Antoine Néel
- Department of Diagnostic Cardio-vascular Imaging, University hospital of Nantes, Nantes, France
| | - Julie Graveleau
- Department of Medicine, Hospital of Saint-Nazaire, Saint-Nazaire, France
| | - Philippe Moreau
- Department of Hematology, Hospital of Lorient, Lorient, France
| | - Hervé Maisonneuve
- Department of Hematology, Hospital of La Roche sur Yon, La Roche sur Yon, France
| | - Georges Fau
- Department of Radiology, University Hospital of Nantes, Nantes, France
| | | | - Mohamed Hamidou
- Department of Diagnostic Cardio-vascular Imaging, University hospital of Nantes, Nantes, France
| | - Christian Agard
- Department of Diagnostic Cardio-vascular Imaging, University hospital of Nantes, Nantes, France.
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32
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Hussain S, Adil SN, Sami SA. Anemia in a middle aged female with aortitis: a case report. BMC Res Notes 2015; 8:594. [PMID: 26493409 PMCID: PMC4619023 DOI: 10.1186/s13104-015-1572-3] [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] [Received: 11/28/2014] [Accepted: 10/12/2015] [Indexed: 11/12/2022] Open
Abstract
Background Idiopathic aortitis is among the most common causes of non-infectious aortitis, which rarely presents with anemia. Case presentation Here we report a case of a 49-year-old muhajir female who presented with shortness of breath and easy fatigability for the past 6 months. Physical examination revealed pallor and a diastolic murmur in the aortic region. Echocardiography showed thickened and calcified aortic and mitral valves, severe aortic regurgitation and dilatation of ascending aorta. She was advised aortic valve replacement and was referred to a haematologist due to concomitant anemia. Complete blood counts revealed haemoglobin: 7.7 gm/dl, mean corpuscular volume (MCV): 78 fl, mean corpuscular haemoglobin (MCH):23 pg, total white cell count: 9.0 × 109/L and platelet count: 227 × 109/L. Erythrocyte sedimentation rate (ESR) was 100 mm/hr. There was suspicion of myelodysplastic syndrome, but could not be confirmed as the patient refused bone marrow and cytogenetic studies. She was given erythropoietin, folic acid and ferrous sulphate. Following relatively prolonged therapy, her haemoglobin level increased to approximately 9.0 gm/dL. She was transfused with packed red cells and underwent aortic valve and ascending aorta replacement. The ascending aorta was dilated and aortic wall markedly thick and irregular. Histopathology of the resected aorta revealed granulomatous aortitis. She was prescribed prednisolone, which resulted in further incremental rise of haemoglobin to 13.1 gm/dL. One month later, she developed complaints of blurred vision in the right eye and was diagnosed with central retinal vein occlusion. She was treated with antiplatelet agents and her vision improved. After 3 months, she was asymptomatic and her haemoglobin level rose to 11.2 gm/dL without hematinic therapy or blood transfusion. She was begun on anticoagulant therapy and remains clinically stable. Conclusion We report a case of idiopathic aortitis with presumed diagnosis of anemia of chronic disease exhibiting a transient response towards steroid therapy post-valvuloplasty.
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Affiliation(s)
- Shabneez Hussain
- Section of Haematology, Department of Pathology and Microbiology, The Aga Khan University Hospital, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan. .,Fatimid Foundation, 393, Britto Road, Garden east, Karachi, 74800, Pakistan.
| | - Salman Naseem Adil
- Section of Haematology, Department of Pathology and Microbiology, The Aga Khan University Hospital, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan.
| | - Shahid Ahmed Sami
- Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan.
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Fior A, Barreto P. Isolated aortitis: a rare cause of febrile illness. BMJ Case Rep 2015; 2015:bcr-2014-209271. [PMID: 26430226 DOI: 10.1136/bcr-2014-209271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Febrile illness often presents a challenge for the clinician. The main causes of febrile illness are infections, solid or haematological malignancies and connective tissue disorders, including vasculitis. A 49-year-old woman sought medical attention because of intermittent fever that lasted 2 weeks. She presented no further symptoms or physical signs to suggest the aetiology. The epidemiological context was irrelevant. Analyses revealed anaemia of chronic disease and significant elevations of inflammatory parameters. A comprehensive study was performed, which revealed presence of an aortitis. Investigation of infectious and immunological causes was negative. We arrived at the definitive diagnosis of isolated aortitis. She was treated with corticosteroid and methotrexate, with resolution of symptoms and clinical abnormalities.
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Affiliation(s)
- Alberto Fior
- Medicina Interna, Unidade Funcional 1.2, Centro Hospitalar de Lisboa Central, Hospital São José, Lisboa, Portugal
| | - Paulo Barreto
- Medicina Interna, Unidade Funcional 1.2, Centro Hospitalar de Lisboa Central, Hospital São José, Lisboa, Portugal
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Influence of aortitis on late outcomes after repair of ascending aortic aneurysms. J Thorac Cardiovasc Surg 2015; 150:589-94. [DOI: 10.1016/j.jtcvs.2015.06.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 06/05/2015] [Accepted: 06/16/2015] [Indexed: 12/28/2022]
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Girardi LN. Noninfectious aortitis and ascending aneurysms: The tip of the iceberg. J Thorac Cardiovasc Surg 2015; 150:595-6. [DOI: 10.1016/j.jtcvs.2015.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 07/06/2015] [Indexed: 11/27/2022]
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Ryan C, Barbour A, Burke L, Sheppard MN. Non-infectious aortitis of the ascending aorta: a histological and clinical correlation of 71 cases including overlap with medial degeneration and atheroma—a challenge for the pathologist. J Clin Pathol 2015; 68:898-904. [DOI: 10.1136/jclinpath-2015-203061] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 06/11/2015] [Indexed: 12/15/2022]
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Stone JR, Bruneval P, Angelini A, Bartoloni G, Basso C, Batoroeva L, Buja LM, Butany J, d'Amati G, Fallon JT, Gittenberger-de Groot AC, Gouveia RH, Halushka MK, Kelly KL, Kholova I, Leone O, Litovsky SH, Maleszewski JJ, Miller DV, Mitchell RN, Preston SD, Pucci A, Radio SJ, Rodriguez ER, Sheppard MN, Suvarna SK, Tan CD, Thiene G, van der Wal AC, Veinot JP. Consensus statement on surgical pathology of the aorta from the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology: I. Inflammatory diseases. Cardiovasc Pathol 2015; 24:267-78. [PMID: 26051917 DOI: 10.1016/j.carpath.2015.05.001] [Citation(s) in RCA: 203] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 05/11/2015] [Accepted: 05/11/2015] [Indexed: 10/23/2022] Open
Abstract
Inflammatory diseases of the aorta include routine atherosclerosis, aortitis, periaortitis, and atherosclerosis with excessive inflammatory responses, such as inflammatory atherosclerotic aneurysms. The nomenclature and histologic features of these disorders are reviewed and discussed. In addition, diagnostic criteria are provided to distinguish between these disorders in surgical pathology specimens. An initial classification scheme is provided for aortitis and periaortitis based on the pattern of the inflammatory infiltrate: granulomatous/giant cell pattern, lymphoplasmacytic pattern, mixed inflammatory pattern, and the suppurative pattern. These inflammatory patterns are discussed in relation to specific systemic diseases including giant cell arteritis, Takayasu arteritis, granulomatosis with polyangiitis (Wegener's), rheumatoid arthritis, sarcoidosis, ankylosing spondylitis, Cogan syndrome, Behçet's disease, relapsing polychondritis, syphilitic aortitis, and bacterial and fungal infections.
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Affiliation(s)
| | | | | | | | | | | | - L Maximilian Buja
- University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | | | | | | | | | | | | | | | - Ornella Leone
- Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Blank N, Hegenbart U, Lohse P, Beimler J, Röcken C, Ho AD, Lorenz HM, Schönland SO. Risk factors for AA amyloidosis in Germany. Amyloid 2015; 22:1-7. [PMID: 25376380 DOI: 10.3109/13506129.2014.980942] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To identify risk factors for serum amyloid-A (AA) amyloidosis in patients living in Germany. METHODS Clinical and genetic data were obtained from 71 patients with AA amyloidosis. SAA1 genotypes were analyzed in 231 individuals. Control groups comprised 45 patients with long-standing inflammatory diseases without AA amyloidosis and 56 age-matched patients without any inflammatory disease. RESULTS The most frequent underlying diseases of AA amyloidosis were familial Mediterranean fever (FMF) (n = 24, 34%) and inflammatory rheumatic diseases (n = 30, 42%). Patients without any known underlying disease (n = 11, 16%) were considered as having idiopathic AA amyloidosis. Patients with FMF were significantly younger at disease onset and younger at diagnosis of AA amyloidosis compared with patients with rheumatic diseases. Patients with idiopathic AA amyloidosis were older than patients with definite rheumatic diseases. Patients with FMF and high penetrance MEFV gene mutations had a relative risk of 1.73 for AA amyloidosis. Patients with FMF or a rheumatic disease and the SAA1 α/α genotype had a relative risk of 4.86 and 2.53, respectively, for developing an AA amyloidosis. The prevalence of this risk genotype was 36% in German patients without an inflammatory disease, 92% in German patients with AA amyloidosis and 100% in German patients with idiopathic AA amyloidosis. CONCLUSIONS Risk factors for AA amyloidosis are the presence of a hereditary autoinflammatory or chronic rheumatic disease, elevated C-reactive protein and SAA serum levels, a long delay of a sufficient therapy, an advanced age and the SAA1α/α genotype.
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Affiliation(s)
- Norbert Blank
- Department of Medicine V, Amyloidosis Center and Division of Rheumatology, University of Heidelberg , Heidelberg , Germany
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Maleszewski JJ. Inflammatory ascending aortic disease: Perspectives from pathology. J Thorac Cardiovasc Surg 2015; 149:S176-83. [DOI: 10.1016/j.jtcvs.2014.07.046] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 07/24/2014] [Indexed: 12/11/2022]
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Ascending aortitis: a clinicopathological study of 21 cases in a series of 300 aortic repairs. Pathology 2015; 46:296-305. [PMID: 24798167 DOI: 10.1097/pat.0000000000000096] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
There are few single-institution clinicopathological series of aortitis. In this study, all ascending aneurysms were prospectively evaluated pathologically with ≥6 aortic sections over a 6-year period.Of 300 ascending aortic resections, there were 21 cases of aortitis (7%), in 11 women and 10 men (mean 67, range 41-88 years). There were 19 patients with aneurysms, and two patients with sclerosing periaortitis, clinically suspected to have intramural haematoma. Of the 19 patients with aneurysms (11 women), two had prior temporal arteritis, one ankylosing spondylitis, one IgA nephropathy, one undifferentiated autoimmune disease, one Lyme disease, and one fibromyalgia. In only two patients was aortitis suspected before surgery as the cause of aneurysm. Four patients developed distal aortic aneurysm requiring repeat surgery. Valve replacement or repair was necessary in nine patients, and two patients died after surgery. There were no significant differences between patients with and without autoimmune disease. The histological features were necrotising aortitis in 18 of 19 patients with aneurysmal aortitis, and there was one case of non-necrotising aortitis. One valve showed autoimmune valvulitis, congenitally bicuspid associated with ankylosing spondylitis. Necrotising aortitis was classified as acute (n = 5), healing (n = 9), and healed (n = 4). Acute necrotising aortitis was associated with need for valve replacement (p = 0.01) and younger age (p = 0.01). The healed phase had subtle histological features, sparse medial inflammation, marked medial attenuation, and chronic adventitial inflammation. Two patients with periaortitis demonstrated marked fibroinflammatory thickening of the adventitia with histological features typical of IgG4-related disease; neither had systemic symptoms. Ascending aortitis is histologically diverse, most frequently of the medial necrotising type, and is usually not suspected pre-operatively. Awareness of the histological spectrum is necessary for pathological diagnosis.
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Hong S, Bae SH, Ahn SM, Lim DH, Kim YG, Lee CK, Yoo B. Outcome of takayasu arteritis with inactive disease at diagnosis: the extent of vascular involvement as a predictor of activation. J Rheumatol 2014; 42:489-94. [PMID: 25512482 DOI: 10.3899/jrheum.140981] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Some patients with Takayasu arteritis (TA) have inactive disease at the time of diagnosis. The objective of our study was to investigate the clinical outcomes and factors that predict disease activation in patients with clinically inactive TA. METHODS The medical records of patients diagnosed with TA between 1990 and 2012 were reviewed. At the time of diagnosis, patients were identified as having inactive disease according to the National Institutes of Health definition. Patients who went on to develop active disease during followup were classified as the "activation group". The pattern of vascular involvement was classified according to the International Conference on TA, 1994. RESULTS A total of 59 patients with TA were classified as having inactive disease at the time of diagnosis. During the followup, 13 (22.0%) of these experienced TA activation (median followup, 37.0 mos; activation group). The remaining 46 (78.0%) did not experience disease activation (stable group). Renovascular hypertension was more common in the activation group than in the stable group (5/13, 38.5% vs 4/46, 8.7%, p = 0.019). Further, type V, which is the most extensive, was more common in the activation group (12/13, 92.3%) than in the stable group (18/46, 39.1%, p = 0.008). Multivariate analysis identified type V disease (OR 10.969, 95% CI 1.144-105.182, p = 0.038) as being significantly associated with an increased risk of disease activation. CONCLUSION Substantial portions of patients with clinically inactive TA at the time of diagnosis experienced disease activation during followup. Type V disease may be an important predictive factor for disease activation in patients with clinically inactive TA.
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Affiliation(s)
- Seokchan Hong
- From the Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.S. Hong, MD, PhD; S-H. Bae, MD; S.M. Ahn, MD; D-H. Lim, MD; Y-G. Kim, MD, PhD; C-K. Lee, MD, PhD; B. Yoo, MD, PhD, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center
| | - Seung-Hyeon Bae
- From the Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.S. Hong, MD, PhD; S-H. Bae, MD; S.M. Ahn, MD; D-H. Lim, MD; Y-G. Kim, MD, PhD; C-K. Lee, MD, PhD; B. Yoo, MD, PhD, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center
| | - Soo Min Ahn
- From the Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.S. Hong, MD, PhD; S-H. Bae, MD; S.M. Ahn, MD; D-H. Lim, MD; Y-G. Kim, MD, PhD; C-K. Lee, MD, PhD; B. Yoo, MD, PhD, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center
| | - Doo-Ho Lim
- From the Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.S. Hong, MD, PhD; S-H. Bae, MD; S.M. Ahn, MD; D-H. Lim, MD; Y-G. Kim, MD, PhD; C-K. Lee, MD, PhD; B. Yoo, MD, PhD, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center
| | - Yong-Gil Kim
- From the Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.S. Hong, MD, PhD; S-H. Bae, MD; S.M. Ahn, MD; D-H. Lim, MD; Y-G. Kim, MD, PhD; C-K. Lee, MD, PhD; B. Yoo, MD, PhD, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center
| | - Chang-Keun Lee
- From the Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.S. Hong, MD, PhD; S-H. Bae, MD; S.M. Ahn, MD; D-H. Lim, MD; Y-G. Kim, MD, PhD; C-K. Lee, MD, PhD; B. Yoo, MD, PhD, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center
| | - Bin Yoo
- From the Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.S. Hong, MD, PhD; S-H. Bae, MD; S.M. Ahn, MD; D-H. Lim, MD; Y-G. Kim, MD, PhD; C-K. Lee, MD, PhD; B. Yoo, MD, PhD, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center.
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A case of Castleman's disease and adult necrotizing aortitis: a co-incidence or a significance? Cardiovasc Pathol 2014; 23:306-9. [PMID: 24849551 DOI: 10.1016/j.carpath.2014.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 04/02/2014] [Indexed: 11/21/2022] Open
Abstract
We report a case of concomitant Castleman's disease and adult necrotizing aortitis, an association heretofore not reported. A brief discussion of the current state of our understanding of the pathogenesis of aortitis and possible link between these two entities is presented.
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43
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Patrício C, da Silva FP, Brotas V. Pulmonary oedema in the emergency room: what is hidden beyond an apparently common presentation. BMJ Case Rep 2014; 2014:bcr-2014-204131. [PMID: 24792026 DOI: 10.1136/bcr-2014-204131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cardiogenic flash pulmonary oedema is a common and potentially fatal cause of acute respiratory distress. Although it often results from acute decompensated heart failure, abrupt-onset aortic regurgitation can sharply rise cardiac filling pressure and, consequently, pulmonary venous pressure, leading to rapid fluid accumulation in the interstitial and alveolar spaces. We report a case of a 64-year-old woman admitted to the emergency department with a flash pulmonary oedema; a careful clinical investigation subsequently revealed a rare aetiology for this 'common' presentation. After a detailed auscultation that unmasked a diastolic cardiac murmur, an acute severe aortic insufficiency was further confirmed by echocardiography, showing inflammation and thickening of the entire aorta wall. The patient was submitted to valve replacement surgery, and histological examination, to our surprise, showed features of aortitis, remarkable for the presence of giant cells. A diagnosis of idiopathic aortitis versus inaugural giant cell arteritis was proposed and treatment started with corticosteroids.
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Affiliation(s)
- Catarina Patrício
- Department of Internal Medicine-3, Hospital de Santo António dos Capuchos, Lisboa, Portugal
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Large vessel vasculitis in elderly patients: early diagnosis and steroid-response evaluation with FDG-PET/CT and contrast-enhanced CT. Rheumatol Int 2014; 34:1545-54. [PMID: 24643395 DOI: 10.1007/s00296-014-2985-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 03/04/2014] [Indexed: 12/16/2022]
Abstract
Large vessel vasculitis (LVV) is an often-reported cause of inflammation of unknown origin (IUO) in elderly people. The objective of this study was to describe the usefulness of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) and contrast-enhanced CT in early diagnosis and treatment follow-up of patients with LVV presenting as elderly onset IUO. We retrospectively compared contrast-enhanced CT findings and FDG-PET/CT findings of the patients diagnosed with LVV and 11 controls; all subjects were 50 years of age or older. We evaluated maximum standardised uptake value (SUV(max)) and PET score of the aortic wall for quantitative comparison of FDG-PET/CT findings. We measured the aortic wall thickness (W) and its ratio against the radius (W/R) for quantitative comparison of aortic wall thickening by contrast-enhanced CT. After steroid treatment, we compared these values with those pre-treatment. Of 124 patients who were hospitalised due to advanced age and IUO, 88 underwent FDG-PET/CT and contrast-enhanced CT. Abnormal findings were observed on images from 78 patients. The findings were indicative of LVV in 13 patients (10.5 %), of whom more than half had only non-specific symptoms. Patients with LVV had significantly higher aortic wall SUV(max) (3.85 vs. 1.95), PET scores by FDG-PET/CT, and aortic wall thicknesses by contrast-enhanced CT (3.8 vs. 2.6 mm) than controls. Significant improvement in aortic wall thickening was evidenced by reduced PET scores and by contrast-enhanced CT findings in patients who were followed up after treatment. LVV is an important cause of IUO with non-specific symptoms in elderly patients. Imaging examination comprising contrast-enhanced CT and FDG-PET/CT is useful for early diagnosis and early treatment evaluation of LVV, allowing for amelioration of reversible aortic wall thickening.
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Abstract
The noninfectious, inflammatory vasculitides include giant cell arteritis, Takayasu disease, Churg-Strauss angiitis, Wegener disease, polyarteritis nodosa, microscopic polyangiitis, Buerger disease, amyloid-β-related angiitis, and isolated vasculitis of the central nervous system. While these disorders are relatively uncommon, they produce a variety of neurologic diseases including muscle disease, mononeuropathy multiplex, polyneuropathy, cranial nerve palsies, visual loss, seizures, an encephalopathy, venous thrombosis, ischemic stroke, and intracranial hemorrhage. The multisystem vasculitides often have stereotypical clinical findings that reflect disease of the kidney, sinuses, lungs, skin, joints, or cardiovascular system. These disorders also usually have abnormalities found on serologic testing. Isolated vasculitis of the central nervous system is more difficult to diagnose because the clinical and brain imaging findings are relatively nonspecific. Examination of the cerebrospinal fluid will demonstrate changes consistent with an inflammatory process. Arteriography often shows areas of segmental narrowing affecting multiple intracranial vessels and brain/meningeal biopsy may be required to establish the diagnosis. Management of patients with a multisystem vasculitis or isolated vasculitis of the central nervous system is centered on the administration of immunosuppressive agents. In many cases, corticosteroids remain the mainstay of medical treatment.
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Affiliation(s)
- Harold P Adams
- Division of Cerebrovascular Diseases, Department of Neurology, Carver College of Medicine, University of Iowa Health Care Stroke Center, University of Iowa, Iowa City, IA, USA.
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Chowdhary VR, Crowson CS, Bhagra AS, Warrington KJ, Vrtiska TJ. CT angiographic imaging characteristics of thoracic idiopathic aortitis. J Cardiovasc Comput Tomogr 2013; 7:297-302. [PMID: 24268116 DOI: 10.1016/j.jcct.2013.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 06/29/2013] [Accepted: 08/16/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Idiopathic aortitis (IA) is characterized by giant cell or lymphoplasmacytic inflammation of aorta without a secondary cause. OBJECTIVE We undertook a retrospective case-control study to identify characteristic CT angiographic findings in these patients and to correlate them with known atherosclerotic risk factors. METHODS IA cases and controls with noninflammatory aneurysm (control group I) and patients with secondary aortitis (control group II) were identified with a pathology database. Preoperative CT angiographic images of thoracic aorta were reviewed. Diameter of thoracic aorta, wall thickness, and calcification were measured at various sites. Traditional atherosclerotic risk factors were identified from case records and included hypertension, hyperlipidemia, diabetes mellitus, and smoking. RESULTS Twenty-two idiopathic aortitis cases were compared with 18 patients in control group I and 16 patients in control group II. No differences were found in prevalence of hypertension and diabetes, but hyperlipidemia was more prevalent in the control group I than in cases (72% vs 36%; P = .03). Current smoking was more prevalent in cases (24%) than for patients in control group I (6%) and group II (19%) but not statistically significant (P = .18 and .69, respectively). Thoracic aortic diameters at various points were significantly larger in cases than for patients in control group I. Calcification was more frequent in cases than for patients in control group II. No differences in wall thickness were found. No meaningful correlation was observed between atherosclerotic risk factors and aortic diameter and calcification scores. CONCLUSIONS Patients with IA have significantly larger and more diffuse dilatation of the thoracic aorta than patients with noninflammatory aneurysms.
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Affiliation(s)
- Vaidehi R Chowdhary
- Division of Rheumatology, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
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Kuzmik GA, Sang AX, Cai G, Tranquilli M, Elefteriades JA. Respecting symptoms in thoracic aortic aneurysm management: a case of symptomatic necrotizing granulomatous aortitis. Int J Angiol 2013; 21:151-4. [PMID: 23997559 DOI: 10.1055/s-0032-1315632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
A 41-year-old woman presented with chest pain of unclear etiology in the setting of a mildly dilated ascending aorta. Computed tomography angiography showed an aorta with an irregular contour and an aneurysm of 4.5 cm. There was no radiographic evidence of rupture or dissection. The patient was taken to the operating room and was found to have severe aortitis with marked localized wall thinning at imminent risk of aortic rupture. Aortic pathology demonstrated necrotizing granulomas of noninfectious etiology. This case illustrates the importance of respecting symptoms in surgical decision making for thoracic aortic aneurysms that may not meet standard interventional criteria.
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Affiliation(s)
- Gregory A Kuzmik
- Aortic Institute, Yale-New Haven Hospital, New Haven, Connecticut
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Aortite et complications aortiques de l’artérite à cellules géantes (maladie de Horton). Rev Med Interne 2013; 34:412-20. [DOI: 10.1016/j.revmed.2013.02.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 02/13/2013] [Indexed: 11/21/2022]
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50
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Josselin-Mahr L, el Hessen TA, Toledano C, Fardet L, Kettaneh A, Tiev K, Cabane J. Aortite inflammatoire au cours de la maladie de Horton. Presse Med 2013; 42:151-9. [DOI: 10.1016/j.lpm.2012.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 02/17/2012] [Accepted: 03/07/2012] [Indexed: 10/28/2022] Open
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