Serial Imaging Changes During Treatment of Immunoglobulin G4–Related Disease With Multiple Pseudotumors

Kusunose, Kenya; Hotchi, Junko; Takagawa, Yuriko; Nishio, S.; Ise, Takayuki; Tobiume, Takeshi; Yamaguchi, Koji; Yagi, Shusuke; Igarashi, Takashi; Yamada, Hirotsugu; Soeki, Takeshi; Wakatsuki, Tetsuzo; Sata, Masataka

doi:10.1161/circulationaha.115.015638

Cited by 15 publications

(10 citation statements)

References 2 publications

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“…[23][24][25] Kusunose and colleagues presented a case with an IgG4-related mass near the inferolateral wall of the left ventricle, 24) and Kouzu and colleagues reported a case with a mass in the right ventricular outflow tract. 24) CT, magnetic resonance imaging, echocardiography, IgG4-related extra-cardiac lesions, and pathologic findings were diagnostic modalities used for definitive diagnosis. Pathologically, IgG4-related tumors consist of spindle-shaped cells within a myxoid stroma.…”

Section: Cardiac Masses (Myocardial Lesions)mentioning

confidence: 99%

Immunoglobulin G4-Related Cardiovascular Diseases

Misawa

2017

ATCS

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Section: Cardiac Masses (Myocardial Lesions)mentioning

confidence: 99%

Immunoglobulin G4-Related Cardiovascular Diseases

Misawa

2017

ATCS

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“…Kouzu and colleagues reported a case with a mass in the right ventricular outflow tract [ 21 ], and Kusunose et al . reported a case with IgG4, which revealed a mass near the inferolateral wall of the left ventricle [ 22 ]. These masses were treated with corticosteroids, and some tumors were resected surgically.…”

Section: Myocardial Lesionsmentioning

confidence: 99%

Multimodalities Imaging of Immunoglobulin 4-related Cardiovascular Disorders

Fathala¹

2019

CCR

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Immunoglobulin 4 (IgG4)-related systemic disease (IgG4-RSD) is a systemic inflammatory disease characterized by elevation of serum IgG4. IgG4-RSD can affect any organ in the body, and the list of organs associated with this condition is growing steadily. IgG4-related cardiovascular disease affects the coronary arteries, heart valves, myocardium, pericardium, aorta, pulmonary and peripheral vessels. Echocardiography is the most commonly used non-invasive imaging method. Computed tomography angiography (CTA) can assess aortitis, periarteritis and coronary aneurysms. Coronary CTA is fast, offers high spatial resolution and a wide coverage field of view. Cardiac magnetic resonance imaging (CMR) offers a comprehensive evaluation of the cardiovascular system including cardiac function, extent of myocardial fibrosis, characterise cardiac masses with different pulse sequences and guide to further treatment. Fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) can provide important information about the extent of disease, the presence of active inflammation and the optimum biopsy site. In general, the role of diagnostic imaging includes establishing the diagnosis, detecting complications, guiding biopsy and documenting response to therapy.

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“…18 F-fluorodeoxyglucose positron emission tomography/ CT (FDG PET/CT) has successfully been used to identify coronary artery involvement of IgG4-RD and to follow up disease activity in IgG4-RD and Takayasu vasculitis. [15][16][17][18][19][20] FDG PET/CT could therefore be considered to gauge the extent of the patient's active inflammation before and after therapy. Additionally, serological IgG4, ESR, and CRP levels have been shown to respond to treatment with corticosteroids and rituximab and seem to correlate with clinical improvement.…”

Section: Patient Presentation (Continued)mentioning

confidence: 99%

“…Various modalities of serial imaging have been used to detect therapeutic response of coronary pseudotumors and iliac artery vascular wall thickening to immunosuppression. 17,19 Depending on the extent of fibrosis before therapy, the patient's aneurysmal disease may respond to continued immunosuppressive therapy. Surveillance imaging will be imperative.…”

Section: Patient Presentation (Continued)mentioning

confidence: 99%

“…10 On the basis of a very small number of initial case reports, similar results may be possible in treating lesions in the cardiovascular system. 19 The optimal surgical or percutaneous approach to addressing vascular disease caused by IgG4-RD has not yet been studied. Until further information is available, it may be reasonable to approach these patients in a manner similar to that used in those with other vasculitides or inflammatory disease.…”

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confidence: 99%

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Bulging at the Root: An Inflammatory Tale

et al. 2016

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1969 ForewordInformation about a real patient is presented in stages (boldface type) to an expert clinician (Dr Bhatt), who responds to the information, sharing his reasoning with the reader (regular type). A discussion by the authors follows. P atient presentation: A 54-year-old man was transferred from an outside institution after he presented to the emergency department following the sudden onset of nonradiating, substernal chest pressure, dyspnea, diaphoresis, and nausea while brushing his teeth. Before transfer, the patient received a full dose of aspirin and was started on unfractionated heparin with biomarker and electrocardiographic evidence of a non-ST-segment-elevation myocardial infarction.His medical history included hypertension, dyslipidemia, long-standing severe atopic dermatitis, and remote large-cell non-Hodgkin lymphoma that had remained in remission for the past 9 years after treatment with rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine, and prednisolone. Over the preceding year, the patient had suffered recurrent admissions for acutely decompensated heart failure with a newly appre- Dr Bhatt: Several features of the patient's recent history are concerning. The cause of the patient's severe LV systolic dysfunction remains undefined. Evidence from large epidemiological studies suggests that in some populations, >60% of unexplained cardiomyopathies may be attributable to coronary heart disease.1 This patient's family history of early coronary artery disease, personal history of classic coronary artery disease risk factors, and regional findings on his myocardial perfusion study support this possibility. In terms of alternative potential causes for his cardiomyopathy, the patient's exposure to doxorubicin places him at up to a 5-fold risk of developing impaired myocardial function, depending on the total cumulative dose of anthracyclines that he received, concomitant radiation exposure, and exposure to additional cardiotoxic medications.2 Additionally, the patient's diffuse aneurysmal disease and rapidly progressive renal disease raise the concern for a possible underlying connective tissue disease, vasculitis, or infectious process. Lastly, renovascular disease is an important and often underrecognized source of recurrent pulmonary edema. This is especially true in the context of a rising serum creatinine level and history of hypertension.In the setting of this patient's non-ST-segment-elevation myocardial infarction with high-risk characteristics, including severe LV dysfunction and recurrent episodes of angina despite medical therapy over the past year, coronary arteriography would be the appropriate next step. Indeed, some experts feel that most patients with unexplained significant LV dysfunction should undergo coronary angiography regardless of stress test findings. Given the extent of the patient's aneurysmal disease and concern for a possible underlying systemic process, a complete CT vascular survey to exclude additional territories of disease would also be reasonab...

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Serial Imaging Changes During Treatment of Immunoglobulin G4–Related Disease With Multiple Pseudotumors

Cited by 15 publications

References 2 publications

Immunoglobulin G4-Related Cardiovascular Diseases

Immunoglobulin G4-Related Cardiovascular Diseases

Multimodalities Imaging of Immunoglobulin 4-related Cardiovascular Disorders

Bulging at the Root: An Inflammatory Tale

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