Imaging modalities in the management of aortitis

Selvaraj, Andrew Dheepak; Francis, Niroshan; Harky, Amer; Goli, Giridhara; Bashir, Mohamad

doi:10.1007/s12055-018-0710-7

Cited by 4 publications

(4 citation statements)

References 30 publications

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“…Unfortunately, as this case shows, oftentimes, etiology cannot be determined solely on imaging techniques despite the predictive accuracy that radiologic features may have, and intra‐operative findings may not be consistent with disease presentation. When there is suspicion for aortitis, positron emission tomography could potentially aid in the diagnosis, monitoring of disease, and differentiating it from IMH, particularly at early phases 5–7 . However, this patient lacked symptoms of rheumatologic disease, inflammatory markers, or other features suggestive of lymphoplasmacytic aortitis that would warrant such imaging at the time.…”

Section: Discussionmentioning

confidence: 95%

Aortitis masquerading as intramural hematoma: When to observe, when to operate? A case report

et al. 2021

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Radiologic evidence of aortic disease is not always consistent with the diagnosis. With a lack of accompanying symptoms or with an atypical presentation, diagnosis, and management of aortic pathology rely greatly on imaging techniques. We report the case of a 58‐year‐old female who presented with incidental radiographic findings consistent with a type A aortic intramural hematoma and a vague left‐sided chest discomfort. After follow‐up, imaging was consistent with disease progression and hematoma expansion; the affected segment was resected and pathology reported lymphoplasmacytic aortitis as the underlying etiology of the imaging findings rather than an intramural hematoma. The patient lacked symptoms or serology consistent with the rheumatologic disease, and the postoperative course was uneventful. The management of a suspected ascending intramural hematoma is controversial, especially when the patient presents with atypical signs and symptoms. Features of disease progression may warrant urgent surgical intervention.

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Section: Discussionmentioning

confidence: 95%

Aortitis masquerading as intramural hematoma: When to observe, when to operate? A case report

et al. 2021

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“…18F-FDG taken up by macrophages and lymphocytes, thus acting as a surrogate marker of increased activity of inflammatory cells. 23 It is important to differentiate lineal diffuse uptake in the wall that is characteristic for vasculitis from patchy uptake that is more suggestive of atherosclerotic disease. 24 CT or MRI can then be used in further morphological assessment of the vessel, thus allowing for a more precise localisation of disease in combined imaging.…”

Section: Imaging Optionsmentioning

confidence: 99%

A review on the deeper understanding of inflammation and infection of the thoracic aorta

et al. 2022

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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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“…Currently, there is no modality of choice in imaging for LVV, but PET scanning is evolving as a technique that can be used as both a diagnostic and prognostic tool. 39 It provides a highly sensitive test, particularly in the early phase, and maintains the ability to localize disease activity with assessment of vascular morphology. CT and MRA are also useful methods in demonstrating stenosis, and providing accurate measurements in aneurysmal disease.…”

Section: Imaging In Vasculitismentioning

confidence: 99%

“…However, this finding on imaging did not correlate to any changes in clinical presentation as 6 of 16 patients had no disease progression despite persistent vessel wall edema on MRI. 39 Interestingly, the presence of vessel wall edema, thought to show active inflammation, was not necessary for the development of new lesions. MRI with high-field strength is also being investigated as a sensitive method to detect temporal artery inflammation.…”

Section: Imaging In Takayasu's Arteritis and Giant Cell Arteritismentioning

confidence: 99%

Current Controversies in Large-Vessel Inflammatory Vasculitis and Thoracic Aortic Aneurysm Disease

et al. 2019

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Large-vessel vasculitis encompasses the spectrum of vasculitides, which pathologically cause chronic granulomatous inflammatory changes, primarily in the aorta and its major branches. These patients are at risk of developing life-threatening aortic lesions that, without recognition and prompt treatment, can cause detrimental effects. Many provocative issues surrounding large-vessel vasculitis and its surgical treatment still remain, spanning from recognition to management. In this review, we discuss the main large-vessel vasculitides, Takayasu's arteritis and giant cell arteritis. We include the key points and current controversies surrounding diagnostic imaging, timing of interventions, and patient outcomes.

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Imaging modalities in the management of aortitis

Cited by 4 publications

References 30 publications

Aortitis masquerading as intramural hematoma: When to observe, when to operate? A case report

Aortitis masquerading as intramural hematoma: When to observe, when to operate? A case report

A review on the deeper understanding of inflammation and infection of the thoracic aorta

Current Controversies in Large-Vessel Inflammatory Vasculitis and Thoracic Aortic Aneurysm Disease

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