Molecular diagnosis of nonaneurysmal infectious aortitis

Kanemitsu, Shinji; Shimono, Takatsugu; Nakamura, Akiko; Yamamoto, Kazuhito; Wada, Hideo; Shimpo, Hideto

doi:10.1016/j.jvs.2010.09.012

Cited by 20 publications

(12 citation statements)

References 9 publications

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“…Nonaneurysmal infectious aortitis is more difficult to diagnose on imaging than MA, given the lack of aortic dilation, but even so may be complicated by rupture (43,44). A more recent case report described achieving an elusive diagnosis of infectious nonaneurysmal infectious aortitis by using broad-range polymerase chain reaction and DNA sequencing, which allowed for identification of the microbial species despite negative blood cultures (45).…”

Section: Nonaneurysmal Infectious Aortitismentioning

confidence: 99%

Inflammatory and infectious aortic diseases

Deipolyi

Czaplicki

Öklü

2018

Cardiovasc. Diagn. Ther.

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Aortitis is aortic inflammation, which can be due to inflammatory or infectious diseases. Left undiagnosed, aortitis can lead to aneurysm formation and rupture, in addition to ischemic compromise of major organs. Infectious aortic diseases include mycotic aneurysm and graft infection; the most common inflammatory diseases are Takayasu's and giant cell arteritis. We review the epidemiology, etiology, presentation and diagnosis, and treatment of these entities. S62infectious extravascular source adjacent the arterial wall (16,17). Bacteria may seed the arterial wall injury either from bacteremia or septic emboli (18). Typically, infection initiates in a nidus such as in an ulcerated atherosclerotic plaque or in the vasa vasorum (12). The vasa vasorum is thought to be key in the pathogenesis of MA formation; due to its small lumen size and slower flow, it is more susceptible to bacterial colonization (19,20). The vasa vasorum is more pronounced in larger arteries, which may explain why the aorta is the most common site of MA formation. DiagnosisEarly diagnosis and rapid triage for intervention is key to reducing mortality from MA (21,22). However, diagnosis is challenging given the low prevalence and nonspecific symptoms. Clinical signs may include fever and laboratory abnormalities including elevated erythrocyte sedimentation rate and leukocytosis (23). Bacteremia is common, though cultures may be negative, particularly after antibiotics have been given. Symptoms include pain or a pulsatile mass (23). In the setting of pre-existing endocarditis, prior invasive procedures, intravenous drug use or immunocompromise should increase suspicion (8,24).Non-invasive cross-sectional imaging is essential in the diagnosis of MA. Computed tomography angiography (CTA) has arisen as the imaging modality of choice owing to its excellent resolution allowing for three-dimensional reconstruction and its rapid acquisition; magnetic resonance imaging (MRI) may also be used (25)(26)(27). Certain features may distinguish MA from non-infected aneurysms, including serial imaging which may reveal rapid progression typical of infected aneurysms. Other characteristic features include contrast-enhancement and a saccular outpouching configuration, whereas non-infected atherosclerotic aneurysms tend to be fusiform (28). Saccular configuration may also suggest imminent rupture, alerting the need for further urgent diagnostic workup. Other features include irregularity of the arterial wall and peri-aortic gas, edema, mass or stranding (28). MAs also tend to have higher uptake on FDG-PET imaging of 4.5 SUV max or more compared with non-infected aneurysms (29). FDG-PET boasts high sensitivity and its potentially high false-positive rate can be improved with simultaneous CT. Treatment and prognosisDue to its elusive presentation, MA is often difficult to treat because of delayed diagnosis. Rapid diagnosis and treatment is key, as aortic MA is associated with 15-50% mortality (7)(8)(9)24). No randomized trials are available to guide manage...

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Section: Nonaneurysmal Infectious Aortitismentioning

confidence: 99%

Inflammatory and infectious aortic diseases

Deipolyi

Czaplicki

Öklü

2018

Cardiovasc. Diagn. Ther.

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“…[6] For non-aneurysmal infectious aortitis, the incidence of non-specific symptoms is higher. [1] In the presence of penetrating injury or trauma in aortic walls, bacterial inoculation is made. Also, bacterial inoculation may occur on an atherosclerotic plaque or a pre-existing aneurysm.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the diagnosis of nonaneurysmal infectious aortitis is challenging and frequently delayed. [1] Delayed treatment of non-aneurysmal infectious aortitis may result in aneurysmal changes, carrying the risk of pseudoaneurysm formation and aortic rupture. [2] In this article, we present a case of non-aneurysmal infectious aortitis who was treated with surgery and pharmacological therapy in the light of literature review.…”

mentioning

confidence: 99%

Non-aneurysmal infectious aortitis presenting with low back pain and abdominal pain

Park¹,

Lee²,

Cho³

2014

Turk Gogus Kalp Dama

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“…69) Ishizaka, et al suggested that IgG4 is also associated with the pathogenesis of infectious aneurysm and aortitis, 70) based on a case of infectious aortitis with IgG4-positive plasmacyte infiltration. 71) Etiologically, inflammatory thoracic aortic aneurysm is prevalent in old females while IAAA and retroperitoneal fibrosis are prevalent in old males, although they have similar histological features. 72) As for symptoms, abdominal or back pain was more commonly observed in patients with non-IgG4-related IAAA than IgG4-related AAA, and low grade fever was equally associated with both inflammatory AAAs.…”

Section: Igg4-related Cardiovascular Diseasementioning

confidence: 99%

IgG4-Related Cardiovascular Disorders

2014

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SummaryImmunoglobulin4 (IgG4)-related disease is a systemic inflammatory disease characterized by elevation of serum IgG4. It involves various organs such as the pancreas (autoimmune pancreatitis), lacrimal gland (Mikulicz's disease), retroperitoneum (retroperitoneal fibrosis), aorta (aortic aneurysm and aortitis), heart (constrictive pericarditis), and pseudotumors around the coronary arteries. These disorders often coexist in accordance with progression of the disease. Because IgG4-related cardiovascular disorder affects the patient's prognosis, early detection and treatment is important. Coronary CT imaging and echocardiography accidentally detect IgG4-related disorders and 18 FDG-PET imaging can identify active inflammation in the lesions. Measurement of serum IgG4 levels and tissue biopsy are necessary for diagnosis. Minor salivary gland biopsy is recommended even though 18 FDG uptake is not detected when it is difficult to obtain a biopsy specimen from IgG4-related cardiovascular lesions. The first-line treatment is high-dose corticosteroid therapy, however, relapse is often reported. Corticosteroids suppress the development of active inflammatory diseases such as aortitis, pericarditis, and pseudotumors, but already-developed lesions do not respond. A large developed aneurysm can rupture even during or after corticosteroid therapy, therefore, additional surgical treatment may be needed. Treatment of IgG4-related cardiovascular disorders might require higher doses of corticosteroids than IgG4-related extracardiovascular disorders. The adequate dose of corticosteroid, type and dose of immunosuppressant, and surgical intervention should be carefully considered on a case-by-case basis. (Int Heart J 2014; 55: 287-295)

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Molecular diagnosis of nonaneurysmal infectious aortitis

Cited by 20 publications

References 9 publications

Inflammatory and infectious aortic diseases

Inflammatory and infectious aortic diseases

Non-aneurysmal infectious aortitis presenting with low back pain and abdominal pain

IgG4-Related Cardiovascular Disorders

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