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1.
Br J Radiol ; 93(1113): 20200103, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32356457

RESUMO

Since its introduction into clinical practice, 2-deoxy-2-[18F]flu-D-glucose (FDG) positron emission tomography/computed tomography (PET/CT) has become firmly established in the field of oncological imaging, with a growing body of evidence demonstrating its use in infectious and inflammatory vascular pathologies. This pictorial review illustrates the utility of FDG PET/CT as a diagnostic tool in the investigation of vascular disease and highlights some of the more common incidental vascular findings that PET reporters may encounter on standard oncology FDG PET/CTs, including atherosclerosis, large vessel vasculitis, complications of vascular grafts, infectious aortitis and acute aortic syndromes.


Assuntos
Fluordesoxiglucose F18 , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Compostos Radiofarmacêuticos , Doenças Vasculares/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças da Aorta/diagnóstico por imagem , Aortite/diagnóstico por imagem , Aterosclerose/diagnóstico por imagem , Prótese Vascular/efeitos adversos , Feminino , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Infecções Relacionadas à Prótese/diagnóstico por imagem , Vasculite/diagnóstico por imagem
2.
Cardiovasc Pathol ; 48: 107223, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32470823

RESUMO

Saprochaete species infection is a rare fungal disease reported so far only in immunocompromised patients. We describe the first case of aortitis caused by Saprochaete capitata, presenting as ascending aorta aneurysm, with secondary endophthalmitis in an immunocompetent patient. Infection by Saprochaete capitata is potentially fatal, with a mortality ranging from 50% to 90% of cases. In the present case aortic aneurysm caused by Saprochaete capitata aortitis was successfully treated by the combination of accurate diagnosis with surgical and specific antifungal therapy.


Assuntos
Aneurisma Infectado/microbiologia , Aneurisma Aórtico/microbiologia , Aortite/microbiologia , Imunocompetência , Infecções Fúngicas Invasivas/microbiologia , Revascularização Miocárdica/efeitos adversos , Saccharomycetales/isolamento & purificação , Idoso , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/imunologia , Aneurisma Infectado/terapia , Antibacterianos/uso terapêutico , Aneurisma Aórtico/diagnóstico , Aneurisma Aórtico/imunologia , Aneurisma Aórtico/terapia , Aortite/diagnóstico , Aortite/imunologia , Aortite/terapia , Implante de Prótese Vascular , Humanos , Infecções Fúngicas Invasivas/diagnóstico , Infecções Fúngicas Invasivas/imunologia , Infecções Fúngicas Invasivas/terapia , Masculino , Saccharomycetales/efeitos dos fármacos , Saccharomycetales/imunologia , Resultado do Tratamento
3.
Gan To Kagaku Ryoho ; 47(5): 851-853, 2020 May.
Artigo em Japonês | MEDLINE | ID: mdl-32408335

RESUMO

BACKGROUND: Pegfilgrastim, a long-acting granulocyte-colony-stimulating factor(G-CSF), has been used as prophylaxis for severe hematotoxicity induced by chemotherapy. We report a case of aortitis induced by pegfilgrastim administration during modified FOLFIRINOX(mFOLFIRINOX)chemotherapy for metastatic pancreatic cancer. CASE REPORT: A 65-year-old woman underwent a distal pancreatectomy for pancreatic tail cancer. Liver metastases appeared 2 years after the surgery. mFOLFIRINOX chemotherapy was started with prophylactic administration of pegfilgrastim. Eight days after the first administration and 6 days after administration of the 8th course, the patient developed a fever. The blood test results indicated severe inflammation. Computed tomography revealed a thickened aorta indicating aortitis. The symptoms rapidly improved with antibiotic therapy. We diagnosed aortitis induced by pegfilgrastim administration. CONCLUSION: Aortitis should be considered when a patient has unidentified inflammatory findings after receiving pegfilgrastim.


Assuntos
Aortite , Fator Estimulador de Colônias de Granulócitos/efeitos adversos , Neoplasias Pancreáticas , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica , Aortite/induzido quimicamente , Feminino , Filgrastim , Granulócitos , Humanos , Neoplasias Pancreáticas/tratamento farmacológico , Polietilenoglicóis , Proteínas Recombinantes
4.
Presse Med ; 49(1): 104018, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32234379

RESUMO

Aortitis and periaortitis are inflammatory diseases of the aorta and its main branches; they differ in the extension of inflammation, which is confined to the aortic wall in aortitis, and spreads to the periaortic space in periaortitis. Aortitis is classified as non-infectious or infectious. Non-infectious aortitis represents a common feature of large-vessel vasculitides but can also be isolated or associated with other rheumatologic conditions. Periaortitis can be idiopathic or secondary to a wide array of etiologies such as drugs, infections, malignancies, and other proliferative diseases. Notably, both aortitis and periaortitis may arise in the context of IgG4-related disease, a recently characterised fibro-inflammatory systemic disease. Prompt recognition, correct diagnosis and appropriate treatment are essential in order to avoid life-threatening complications.


Assuntos
Aortite , Aorta/patologia , Aortite/classificação , Aortite/diagnóstico , Aortite/etiologia , Aortite/patologia , Diagnóstico por Imagem/métodos , Arterite de Células Gigantes/diagnóstico , Arterite de Células Gigantes/etiologia , Arterite de Células Gigantes/patologia , Humanos , Doença Relacionada a Imunoglobulina G4/complicações , Fibrose Retroperitoneal/complicações , Fibrose Retroperitoneal/patologia , Arterite de Takayasu/diagnóstico , Arterite de Takayasu/etiologia , Arterite de Takayasu/patologia
5.
Clin Exp Rheumatol ; 38 Suppl 124(2): 99-106, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32242814

RESUMO

OBJECTIVES: We compared the diagnostic value of fully integrated 18F-FDG PET/MRI to that of clinical and serological markers for monitoring disease activity in patients with aortitis/chronic periaortitis (A/CPA) during immunosuppressive therapy. METHODS: Patients positive for A/CPA at the initial and at least 2 consecutive PET/MRI studies were included for retrospective analysis. Imaging (qualitative and quantitative analysis), clinical, and serologic (C-reactive protein, erythrocyte sedimentation rate) assessments were determined at each visit, and their findings compared. Differences in various PET/MRI parameters, clinical symptoms, and serologic markers during therapy between first and second visits were tested for statistical significance. Spearman's rank correlation coefficient was calculated to relate imaging to serologic marker changes between the first 2 visits. RESULTS: Serial assessments were performed in 12 patients with A/CPA, over 34 visits. PET/MRI suggested active disease in 22/34 (64.7%) studies, whereas clinical assessment and serological analysis were positive in only 18/34 (52.9%) and 17/34 (50%) cases, respectively. Disease activity assessment differed between PET/MRI, and clinical and serological markers, in 8/34 (23.5%) and 9/34 (26.5%) cases, respectively. Imaging and serologic parameters (p < 0.009) and clinical symptoms (p = 0.063) predominantly improved at the second visit. Changes from the first to the second visit were not correlated between PET/MRI and serologic markers. CONCLUSIONS: Fully integrated 18F-FDG PET/MRI provides a comprehensive imaging approach with data on vascular/perivascular inflammation that is complementary to clinical and laboratory assessments. This highlights the potential value of imaging-based disease activity monitoring, which might have a crucial impact on clinical management in patients with A/CPA.


Assuntos
Aortite/diagnóstico por imagem , Imagem por Ressonância Magnética , Tomografia por Emissão de Pósitrons , Fibrose Retroperitoneal/diagnóstico por imagem , Aortite/sangue , Fluordesoxiglucose F18 , Humanos , Fibrose Retroperitoneal/sangue , Estudos Retrospectivos
8.
Open Heart ; 7(1): e001141, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32201583

RESUMO

Objective: Using combined positron emission tomography and CT (PET-CT), we measured aortic inflammation and calcification in patients with abdominal aortic aneurysms (AAA), and compared them with matched controls with atherosclerosis. Methods: We prospectively recruited 63 patients (mean age 76.1±6.8 years) with asymptomatic aneurysm disease (mean size 4.33±0.73 cm) and 19 age-and-sex-matched patients with confirmed atherosclerosis but no aneurysm. Inflammation and calcification were assessed using combined 18F-FDG PET-CT and quantified using tissue-to-background ratios (TBRs) and Agatston scores. Results: In patients with AAA, 18F-FDG uptake was higher within the aneurysm than in other regions of the aorta (mean TBRmax2.23±0.46 vs 2.12±0.46, p=0.02). Compared with atherosclerotic control subjects, both aneurysmal and non-aneurysmal aortae showed higher 18F-FDG accumulation (total aorta mean TBRmax2.16±0.51 vs 1.70±0.22, p=0.001; AAA mean TBRmax2.23±0.45 vs 1.68±0.21, p<0.0001). Aneurysms containing intraluminal thrombus demonstrated lower 18F-FDG uptake within their walls than those without (mean TBRmax2.14±0.43 vs 2.43±0.45, p=0.018), with thrombus itself showing low tracer uptake (mean TBRmax thrombus 1.30±0.48 vs aneurysm wall 2.23±0.46, p<0.0001). Calcification in the aneurysmal segment was higher than both non-aneurysmal segments in patients with aneurysm (Agatston 4918 (2901-8008) vs 1017 (139-2226), p<0.0001) and equivalent regions in control patients (442 (304-920) vs 166 (80-374) Agatston units per cm, p=0.0042). Conclusions: The entire aorta is more inflamed in patients with aneurysm than in those with atherosclerosis, perhaps suggesting a generalised inflammatory aortopathy in patients with aneurysm. Calcification was prominent within the aneurysmal sac, with the remainder of the aorta being relatively spared. The presence of intraluminal thrombus, itself metabolically relatively inert, was associated with lower levels of inflammation in the adjacent aneurysmal wall.


Assuntos
Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aortite/diagnóstico por imagem , Aortografia , Aterosclerose/diagnóstico por imagem , Placa Aterosclerótica , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Calcificação Vascular/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Inglaterra , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Escócia , Índice de Gravidade de Doença
10.
BMJ Case Rep ; 13(1)2020 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-31941668

RESUMO

A 72-year-old man was admitted with complaints of sudden-onset oppressive precordial pain radiating to the back for 1 hour. He had hypotension, peripheral cyanosis and cold extremities. An initial assessment was done and acute coronary syndrome was excluded. After the patient was admitted, he developed fever and increased levels of inflammatory markers. Data obtained from CT angiography and transoesophageal echocardiogram revealed diffuse parietal thickening of the arch and the descending thoracic aorta, as well as dilatation of the aortic root and the proximal ascending aorta. In addition, the test for Borrelia burgdorferi was positive, and the patient was diagnosed with Lyme vasculitis of the thoracic aorta. He was treated with doxycycline for 3 weeks. Two months later, the patient exhibited a Stanford type A aortic dissection (clinically stable), which was treated by prosthesis replacement. The patient has remained asymptomatic for 1 year after the episode, performing his routine daily activities.


Assuntos
Aneurisma Dissecante/microbiologia , Aneurisma da Aorta Torácica/microbiologia , Aortite/microbiologia , Doença de Lyme/complicações , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Aortite/diagnóstico por imagem , Aortite/cirurgia , Implante de Prótese Vascular , Borrelia burgdorferi , Diagnóstico Diferencial , Humanos , Masculino
11.
Cardiovasc Pathol ; 46: 107175, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31951962

RESUMO

Aortic syphilis today is infrequently diagnosed clinically. Described herein are findings in 5 women who had resection of a fusiform aneurysm of the tubular portion of ascending aorta, and examination of the wall of the aneurysm disclosed classic features of aortic syphilis. The 5 patients were among 36 who had ascending aortic operations at Baylor University Medical Center in Dallas in 2018 and early 2019. Syphilitic aneurysm in each spared the sinus portion and involved diffusely the tubular portion of ascending aorta, beginning at the sinotubular junction. The aneurysmal wall was thicker than normal because of thickening of both intima and adventitia. The latter contained foci of lymphocytes and plasmacytes and thickened and narrowed vasa vasora. The media was disrupted by fibrous scars, which weakened the integrity of the aorta. Aortitis of the tubular portion of ascending aorta in syphilis is a diffuse process, but often is mistakenly called "atherosclerosis" which, when present in this portion of aorta, can be extensive but is focal. Aortic syphilis is important to diagnose so that patients can receive antibiotic therapy to delay, prevent, or treat neurosyphilis, a common accompaniment of aortic syphilis.


Assuntos
Aneurisma Infectado/microbiologia , Aorta/microbiologia , Aneurisma Aórtico/microbiologia , Aortite/microbiologia , Sífilis Cardiovascular/microbiologia , Idoso , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/patologia , Aneurisma Infectado/cirurgia , Antibacterianos/uso terapêutico , Aorta/diagnóstico por imagem , Aorta/patologia , Aorta/cirurgia , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/patologia , Aneurisma Aórtico/cirurgia , Aortite/diagnóstico por imagem , Aortite/patologia , Aortite/cirurgia , Aortografia , Biópsia , Implante de Prótese Vascular , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Fatores de Risco , Sífilis Cardiovascular/diagnóstico por imagem , Sífilis Cardiovascular/patologia , Sífilis Cardiovascular/cirurgia , Texas , Resultado do Tratamento
15.
Eur J Vasc Endovasc Surg ; 59(3): 464-471, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31708339

RESUMO

OBJECTIVE: This study aimed to evaluate the feasibility of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) combined with contrast enhanced magnetic resonance imaging (MRI) to identify inflammation in asymptomatic abdominal aortic aneurysms (AAA). METHODS: FDG PET/MRI was performed on 15 patients with asymptomatic infrarenal AAAs >45 mm diameter. Prevalence of FDG uptake and MRI findings of inflammatory changes (oedema, wall thickening, and late gadolinium enhancement [LGE]) in the aortic wall were investigated at three levels: suprarenal aorta; non-aneurysmal aortic neck; and AAA. RESULTS: The median diameter of the AAAs was 54 mm (range 47-65 mm) and the median expansion rate in the last 12 months was 3 mm (range 1-13 mm). The standard uptake value (SUV) of FDG in the aneurysmal wall (SUVmax 2.5) was higher than the blood pool (SUVmax 1.0; p < .001). The maximum target to background ratio was higher in the suprarenal aorta (mean ± SD; 3.1 ± 0.6) and aortic neck (2.7 ± 0.5) than in the aneurysmal aorta (2.5 ± 0.5; p < .001). Thirty-six FDG hotspots were observed in the aneurysmal wall of 13 patients. Wall thickening and LGE were identified in eight patients. The number of FDG hotspots correlated with recent AAA growth (r = 0.62, p = .01). The recent aneurysm expansion rate was higher in aneurysms with LGE than in those without (7 mm vs. 2 mm; p = .03). MRI inflammatory changes were observed in nine of 36 hot spots (25%) and in three of 13 patients with focal FDG uptake. CONCLUSION: Fully integrated FDG PET/MRI can be used to study inflammation in asymptomatic AAAs. Heterogenous uptake of FDG in the aneurysmal wall indicates increased glucose metabolism, suggesting an ongoing inflammation. However, these FDG hotspots rarely correspond to MRI findings of inflammation, raising the question of which type of cellular activity is present in these areas. The presence of LGE and FDG hotspots both correlated to recent aneurysm growth, and their usefulness as clinical markers of aneurysm growth warrant additional investigation.


Assuntos
Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aortite/diagnóstico por imagem , Fluordesoxiglucose F18/administração & dosagem , Angiografia por Ressonância Magnética , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Doenças Assintomáticas , Progressão da Doença , Estudos de Viabilidade , Humanos , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Valor Preditivo dos Testes , Prognóstico
16.
Eur J Ophthalmol ; 30(2): NP35-NP37, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30642193

RESUMO

A 73-year-old woman with a history of muscular weakness and dyspnoea of unknown etiology was referred to our Ophthalmology Department for dacryocystitis. Lacrimal sac biopsy revealed IgG4 plasma cell infiltration and systemic diagnosis was done based on this, allowing an appropriate treatment to be established. To our knowledge, this is the first reported case of IgG4-related dacryocystitis associated to aortitis.


Assuntos
Aortite/imunologia , Dacriocistite/imunologia , Imunoglobulina G/sangue , Aparelho Lacrimal/patologia , Idoso , Feminino , Humanos
17.
Ann Rheum Dis ; 79(1): 19-30, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31270110

RESUMO

BACKGROUND: Since the publication of the European League Against Rheumatism (EULAR) recommendations for the management of large vessel vasculitis (LVV) in 2009, several relevant randomised clinical trials and cohort analyses have been published, which have the potential to change clinical care and therefore supporting the need to update the original recommendations. METHODS: Using EULAR standardised operating procedures for EULAR-endorsed recommendations, the EULAR task force undertook a systematic literature review and sought opinion from 20 experts from 13 countries. We modified existing recommendations and created new recommendations. RESULTS: Three overarching principles and 10 recommendations were formulated. We recommend that a suspected diagnosis of LVV should be confirmed by imaging or histology. High dose glucocorticoid therapy (40-60 mg/day prednisone-equivalent) should be initiated immediately for induction of remission in active giant cell arteritis (GCA) or Takayasu arteritis (TAK). We recommend adjunctive therapy in selected patients with GCA (refractory or relapsing disease, presence of an increased risk for glucocorticoid-related adverse events or complications) using tocilizumab. Methotrexate may be used as an alternative. Non-biological glucocorticoid-sparing agents should be given in combination with glucocorticoids in all patients with TAK and biological agents may be used in refractory or relapsing patients. We no longer recommend the routine use of antiplatelet or anticoagulant therapy for treatment of LVV unless it is indicated for other reasons. CONCLUSIONS: We have updated the recommendations for the management of LVV to facilitate the translation of current scientific evidence and expert opinion into better management and improved outcome of patients in clinical practice.


Assuntos
Antirreumáticos/uso terapêutico , Arterite de Células Gigantes/tratamento farmacológico , Glucocorticoides/uso terapêutico , Arterite de Takayasu/tratamento farmacológico , Anticorpos Monoclonais Humanizados/uso terapêutico , Aortite/diagnóstico por imagem , Aortite/tratamento farmacológico , Aortite/patologia , Arterite de Células Gigantes/diagnóstico por imagem , Arterite de Células Gigantes/patologia , Humanos , Metotrexato/uso terapêutico , Arterite de Takayasu/diagnóstico por imagem , Arterite de Takayasu/patologia
18.
J Card Surg ; 35(2): 514-517, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31872897

RESUMO

BACKGROUND: Clostridium septicum aortitis is a lethal infection. C. septicum has a strong association with an underlying malignancy, most commonly in the colon. AIM: Early identification methods and management strategies of C. Septicum infection. MATERIALS AND METHODS: We present a 64-year-old man with aortic aneurysm and C. septicum bacteremia with unknown malignancy who passed away on the fourth day of hospitalization despite emergent endovascular intervention. Computed tomography showed periaortic gas which is the hallmark of infection. DISCUSSION: This case report highlights the need of prompt surgical treatment and its different modalities along with the early use of appropriate antibiotics due to the rapid spread of infection associated with high fatality. The authors also discuss the association of C. septicum aortitis with underlying occult malignancies. CONCLUSION: Delay in identification and treatment of C. Septicum is associated with very high mortality rates.


Assuntos
Aorta/cirurgia , Aortite/microbiologia , Aortite/terapia , Infecções por Clostridium , Clostridium septicum , Antibacterianos/administração & dosagem , Aortite/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Emergências , Procedimentos Endovasculares/métodos , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Stents , Tomografia Computadorizada por Raios X
19.
Z Rheumatol ; 79(5): 475-481, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31858218

RESUMO

Patients with immunoglobulin G4-related thoracic aortitis often have nonspecific symptoms, but pain in the chest or back is common. The rate of misdiagnosis of immunoglobulin G4-related thoracic aortitis is high, which may lead to mistreatment in extreme cases. A correct diagnosis should be based on comprehensive medical imaging, pathology, and laboratory and immunohistochemical results. Most patients' condition can be significantly improved using conservative or surgical treatment.


Assuntos
Aortite , Imunoglobulina G/sangue , Aortite/diagnóstico , Aortite/imunologia , Humanos , Inflamação/diagnóstico , Inflamação/imunologia
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