Retroperitoneal fibrosis associated with aortitis

Kuwana, Masataka; Wakino, Shu; Yoshida, Tadashi; Homma, Mitsuo

doi:10.1002/art.1780351020

Cited by 17 publications

(6 citation statements)

References 14 publications

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“…Moreover, autopsy studies have shown that moderate adventitial inflammation and fibrosis may not be limited to the abdominal aorta, but also involve its thoracic portion (25,26). In fact, aortic arch syndrome has been reported in CP, confirming the possible involvement of the thoracic aorta (13). Our findings show that by using FDG-PET, vascular inflammation in the thoracic aorta and/or its branches may be detected in approximately half of the cases.…”

Section: Discussionsupporting

confidence: 68%

“…Likewise, in a recent study, we found that in 7 (44%) of 16 cases CP was associated with other autoimmune conditions, namely ANCA-positive renal disease and autoimmune tyroiditis (7). Finally, various case reports have described an association between CP and numerous autoimmune diseases including well-defined small-and medium-vessel vasculitis (Wegener's granulomatosis, polyarteritis nodosa, Henoch-Schoenlein purpura) (9 -11), unclassifiable "systemic vasculitis" (8,12), aortitis (13), or different types of immune-mediated glomerulonephritis (membranous, membrano-proliferative, and rapidly progressive glomerulonephritis) (18,19). Ankylosing spondylitis, a condition sometimes linked to ascending aortitis, has also been reported to be associated with CP (12,20,21), whereas the association with rheumatoid arthritis and systemic lupus erythematosus is uncommon (7,22).…”

Section: Discussionmentioning

confidence: 92%

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Positron emission tomography (PET): Evaluation of chronic periaortitis

Salvarani¹,

Pipitone²,

Versari³

et al. 2005

Arthritis & Rheumatism

131

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Objective. To evaluate the presence and extent of large-vessel inflammation in patients with chronic periaortitis (CP) using 18 F-fluorodeoxyglucose-positron emission tomography (FDG-PET). Methods. A consecutive case series consisting of 7 patients with CP seen over a 3-year period and a control group of 14 patients with malignancy were evaluated with FDG-PET. For every case we selected 2 age-and sex-matched controls who underwent PET imaging for malignancy. The diagnosis of CP was made by means of computed tomography. PET imaging was performed at diagnosis before therapy was started. Measurement of vascular uptake was graded using a 4-point semiquantitative scale. Results. All patients had evidence of grade 2؉ or 3؉ vascular uptake in the abdominal aorta and/or iliac artery. No controls showed vascular uptake greater than 1؉. Vascular uptake in the thoracic aorta and/or in its branches was seen in 3 (43%) of 7 patients. Vascular uptake in abdominal aorta and/or iliac artery was observed in patients with CP but not in controls (100% versus 0%). There was also a significantly more frequent FDG uptake in the large thoracic arteries in case-patients compared with controls (43% versus 0%; P ‫؍‬ 0.03). Conclusion. FDG-PET scan shows in patients with CP the presence of a large-vessel vasculitis involving abdominal aorta and common iliac arteries, which in some patients is also extended to thoracic aorta and/or its branches.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 92%

Positron emission tomography (PET): Evaluation of chronic periaortitis

Salvarani¹,

Pipitone²,

Versari³

et al. 2005

Arthritis & Rheumatism

131

View full text Add to dashboard Cite

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“…Syphilitic aortitis, localized in only the wall of the ascending aorta, is reported in several recent case reports [ 86 – 88 ]. Aortitis also occurs in association with idiopathic retroperitoneal fibrosis (Ormond's disease), inflammatory abdominal aortic aneurysm, and perianeurysmal retroperitoneal fibrosis, a group of clinical disorders now categorized as chronic periaortitis [ 89 ].…”

Section: Specificity and Differential Diagnosis Of Pathologic mentioning

confidence: 99%

The Role of¹⁸F-FDG PET/CT in Large-Vessel Vasculitis: Appropriateness of Current Classification Criteria?

Balink

Bennink

Eck-Smit

et al. 2014

BioMed Research International

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Patients with clinical suspicion of large-vessel vasculitis (LVV) may present with nonspecific signs and symptoms and increased inflammatory parameters and may remain without diagnosis after routine diagnostic procedures. Both the nonspecificity of the radiopharmaceutical 18F-FDG and the synergy of integrating functional and anatomical images with PET/CT offer substantial benefit in the diagnostic work-up of patients with clinical suspicion for LVV. A negative temporal artery biopsy, an ultrasonography without an arterial halo, or a MRI without aortic wall thickening or oedema do not exclude the presence of LVV and should therefore not exclude the use of 18F-FDG PET/CT when LVV is clinically suspected. This overview further discusses the notion that there is substantial underdiagnosis of LVV. Late diagnosis of LVV may lead to surgery or angioplasty in occlusive forms and is often accompanied by serious aortic complications and a fatal outcome. In contrast to the American College of Rheumatology 1990 criteria for vasculitis, based on late LVV effects like arterial stenosis and/or occlusion, 18F-FDG PET/CT sheds new light on the classification of giant cell arteritis (GCA) and Takayasu arteritis (TA). The combination of these observations makes the role of 18F-FDG PET/CT in the assessment of patients suspected for having LVV promising.

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“…43Y45 Consistent with this hypothesis, a recent study demonstrated that all patients with CP had evidence on FDG-PET of grade 2+ or 3+ vascular uptake in the abdominal aorta and/or iliac artery, consistent with widespread large-vessel vasculitis involving these arteries. 40 Vasculitis of the thoracic aorta and/or its branches was documented by FDG-PET, CT angiography, and MRA in 34% of 41 consecutive Italian CP patients, 47 while reports of aortic arch syndrome in CP appear to confirm that CP may also affect the thoracic aorta 21,23 (Table 4). Along the same lines, autopsy studies have shown that the adventitial inflammation and fibrosis seen in CP may not be limited to the abdominal aorta, but may also involve the thoracic portion.…”

Section: Discussionmentioning

confidence: 99%

Vasculitis of the Gastrointestinal Tract in Chronic Periaortitis

et al. 2011

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The term "chronic periaortitis" (CP), proposed by Mitchinson in 1984, comprises 3 main entities: idiopathic retroperitoneal fibrosis (IRF), inflammatory abdominal aortic aneurysms (IAAAs), and perianeurysmal retroperitoneal fibrosis (PRF).The presence of constitutional symptoms, high acute-phase reactants, positive autoantibodies, and associated autoimmune diseases suggests a systemic inflammatory process. Histopathologic findings show vasculitis with fibrinoid necrosis involving the aortic vasa vasorum as well as the small and medium retroperitoneal vessels.We reviewed the medical records of 608 patients with a diagnosis of vasculitis involving the gastrointestinal (GI) tract at the Mayo Clinic between January 1996 and December 2007. Only patients with biopsy-proven or typical angiographic findings of vasculitis localized to the GI tract were included.Five patients were identified with evidence of CP (1 patient with PRF, 1 with IRF, and 3 with IAAAs). Three patients were men, and the median age at diagnosis was 49 years. The diagnosis of GI vasculitis and CP was made simultaneously in 4 patients. At the time of onset, all patients had abdominal pain and constitutional manifestations; the median erythrocyte sedimentation rate was 62.5 mm/1 h (range, 20-86 mm/1 h). All patients had evidence of mesenteric vasculitis at angiography. Three patients also had associated renal artery stenoses. Abdominal computed tomography showed spleen infarcts in 2 patients, bowel wall thickening in 1, and liver infarction in 1. Two patients underwent surgical intervention for acute abdomen; there was histologic evidence of small bowel infarcts and infarction of the spleen and liver in 1. Oral prednisone was administered to all 5 patients (median starting dose, 60 mg/d; range, 25-80 mg/d). Three patients also received immunosuppressive agents, 1 tamoxifen, and 1 anti-tumor necrosis factor therapy. All patients had at least 1 relapse or recurrence of vasculitis, but at last visit, GI vasculitis and CP were in remission in all 5 patients.This study provides evidence that GI manifestations due to mesenteric vasculitis may be associated with CP. Vasculitic involvement of the renal arteries is also frequently present in these patients. Aggressive immunosuppressive treatment should be promptly initiated to forestall abdominal complications. These findings reinforce the hypothesis that a vasculitic process plays an important role in the pathogenesis of CP.

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Retroperitoneal fibrosis associated with aortitis

Cited by 17 publications

References 14 publications

Positron emission tomography (PET): Evaluation of chronic periaortitis

Positron emission tomography (PET): Evaluation of chronic periaortitis

The Role of¹⁸F-FDG PET/CT in Large-Vessel Vasculitis: Appropriateness of Current Classification Criteria?

Vasculitis of the Gastrointestinal Tract in Chronic Periaortitis

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Retroperitoneal fibrosis associated with aortitis

Cited by 17 publications

References 14 publications

Positron emission tomography (PET): Evaluation of chronic periaortitis

Positron emission tomography (PET): Evaluation of chronic periaortitis

The Role of18F-FDG PET/CT in Large-Vessel Vasculitis: Appropriateness of Current Classification Criteria?

Vasculitis of the Gastrointestinal Tract in Chronic Periaortitis

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The Role of¹⁸F-FDG PET/CT in Large-Vessel Vasculitis: Appropriateness of Current Classification Criteria?