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1.
Khirurgiia (Mosk) ; (5): 123-128, 2024.
Article Ru | MEDLINE | ID: mdl-38785248

Syphilitic aortitis is a rare disease caused by Treponema pallidum affecting the aorta and leading to inflammation. Syphilitic aortitis is one of the causes of aortic aneurysms. This article presents surgical treatment of a patient with syphilitic aortitis and thoracic aortic aneurysm. This clinical case confirms the difficulties of surgical treatment.


Aortic Aneurysm, Thoracic , Syphilis, Cardiovascular , Humans , Syphilis, Cardiovascular/diagnosis , Syphilis, Cardiovascular/surgery , Syphilis, Cardiovascular/complications , Male , Aortic Aneurysm, Thoracic/surgery , Aortic Aneurysm, Thoracic/diagnosis , Treatment Outcome , Treponema pallidum/isolation & purification , Blood Vessel Prosthesis Implantation/methods , Middle Aged , Aortitis/diagnosis , Aortitis/surgery , Aortitis/microbiology
2.
Cardiovasc Pathol ; 71: 107651, 2024.
Article En | MEDLINE | ID: mdl-38679299

BACKGROUND: This study aimed to explore the clinical and pathological features of aortitis in China, which is a rare disease that is often overlooked preoperatively. METHODS: We reviewed the records of 2950 patients who underwent aortic surgery at Wuhan Asia General Hospital from 2016 to 2023. Clinical and pathological data were collected and compared across different groups. RESULTS: Out of 2950 patients, 15 had healed aortitis, 2 were healed Takayasu aortitis (TAK), and 13 were not further classified. Forty-two had active aortitis, including clinically isolated aortitis ([CIA], 42.9%), infectious aortitis ([IA], 26.2%), TAK (16.7%), and Behçet's syndrome ([BS], 14.3%), half of these cases were not recognized preoperatively. All patients who developed perivalvular leakage during follow-up had concurrent non-infectious valvulitis with mixed inflammatory pattern at the time of initial surgery. Seventeen out of 18 patients with CIA survived without complications, as did 8 out of 11 patients with IA, 6 out of 7 patients with TAK, and 2 out of 6 patients with BS. CONCLUSIONS: Half of the aortitis cases were initially diagnosed by pathologists. Noninfectious valvulitis with mixed inflammatory pattern is a risk factor for perivalvular leakage. BS is associated with a higher rate of complications. Patients with CIA have a good prognosis in China, which is different from the West.


Aortitis , Takayasu Arteritis , Humans , Male , Female , China/epidemiology , Middle Aged , Adult , Aortitis/pathology , Aortitis/epidemiology , Aortitis/surgery , Takayasu Arteritis/epidemiology , Takayasu Arteritis/pathology , Takayasu Arteritis/complications , Retrospective Studies , Aged , Young Adult , Behcet Syndrome/complications , Behcet Syndrome/pathology , Behcet Syndrome/epidemiology , Behcet Syndrome/diagnosis , Risk Factors , Predictive Value of Tests , Treatment Outcome , Aorta/pathology , Aorta/surgery , Adolescent , Prognosis , East Asian People
3.
BMJ Case Rep ; 17(3)2024 Mar 27.
Article En | MEDLINE | ID: mdl-38538095

Infectious aortitis is a rare disease process which can be of fungal, viral or bacterial aetiology. This disease process is often incidentally found during concomitant infectious processes, likely due to haematogenous spread. Common sources are from cardiac, genitourinary and gastroenterologic sources. CT imaging of the aorta is essential in identifying physiological changes-wall thickness changes, ectasia and stenosis. We present a case of a female in her early 60s with a medical history of cardiomyopathy with heart failure and reduced ejection fraction, who was initially admitted for acute cholecystitis complicated by the development of gallstone pancreatitis. Imaging evaluation incidentally noted findings consistent with aortitis with a penetrating ulcer, and blood cultures were positive for Staphylococcus aureus bacteraemia, confirming her diagnosis of infectious aortitis. She was started on intravenous antibiotics, required preoperative nutritional optimisation, and subsequently underwent an open aortic resection and aortoiliac reconstruction with rifampin-soaked Dacron graft.


Aortitis , Bacteremia , Soft Tissue Infections , Staphylococcal Infections , United States , Humans , Female , Aortitis/diagnosis , Aortitis/therapy , Aortitis/complications , Bacteremia/complications , Hospitals, Military , Staphylococcal Infections/complications , Staphylococcus aureus , Soft Tissue Infections/complications
4.
Int J Hematol ; 119(5): 608-612, 2024 May.
Article En | MEDLINE | ID: mdl-38521841

Aortitis is a rare adverse event of granulocyte colony-stimulating factor (G-CSF) treatment. Several previous studies have described recurrent aortitis caused by re-administration of the same G-CSF. However, no previous studies have examined the safety of switching between short-acting G-CSFs in patients who develop aortitis. We report the case of a 55-year-old man with refractory diffuse large B-cell lymphoma, who developed G-CSF-associated aortitis. The aortitis was triggered by filgrastim and recurred after treatment with lenograstim. The patient possessed human leukocyte antigen B52, which has been implicated in Takayasu arteritis. In addition, a drug-induced lymphocyte stimulation test for lenograstim performed upon detection of recurrent G-CSF-associated aortitis produced a positive result. Our case suggests that switching from one short-acting G-CSF to another does not prevent recurrence of G-CSF-associated aortitis. Although the etiology of G-CSF-associated aortitis has not been fully elucidated, our case also suggests that some patients may be genetically predisposed to aortitis.


Aortitis , Granulocyte Colony-Stimulating Factor , HLA-B52 Antigen , Lymphoma, Large B-Cell, Diffuse , Humans , Male , Granulocyte Colony-Stimulating Factor/adverse effects , Granulocyte Colony-Stimulating Factor/administration & dosage , Middle Aged , Lymphoma, Large B-Cell, Diffuse/drug therapy , Aortitis/chemically induced , Aortitis/etiology , HLA-B52 Antigen/adverse effects , Filgrastim/adverse effects , Filgrastim/administration & dosage , Lenograstim , Drug Substitution , Recombinant Proteins/adverse effects , Recombinant Proteins/administration & dosage , Recombinant Proteins/therapeutic use
7.
Eur Arch Otorhinolaryngol ; 281(4): 2037-2040, 2024 Apr.
Article En | MEDLINE | ID: mdl-38308762

INTRODUCTION: Immune-related adverse events (irAEs) due to immune checkpoint inhibitors may lead to discontinuation and treatment-related death. Acute aortitis is a rare but severe irAE. CASE PRESENTATION: A 67-year-old man with recurrent lower gingival carcinoma received nivolumab therapy. Twenty-three months later, he experienced chest compression, which resulted in syncope. Following a whole-body computed tomography (CT) scanning, which revealed diffuse thickening of the aorta, and systemic assessments of the causes of aortitis, he was diagnosed with acute aortitis due to irAE. Nivolumab discontinuation and oral steroids improved CT findings. However, 11 months after nivolumab discontinuation, he developed an aortic aneurysmal rupture. Endovascular aortic repair rescued him. A durable anti-cancer response was still observed 4 months after the aortic rupture. CONCLUSION: Although severe irAE, such as acute aortitis, occurred, the patient may still achieve a durable response. A broad examination and prompt treatment of irAE can help improve the patient's survival.


Aortic Rupture , Aortitis , Carcinoma , Humans , Male , Aged , Nivolumab/adverse effects , Aortitis/chemically induced , Aortitis/diagnostic imaging , Aortic Rupture/chemically induced , Aortic Rupture/diagnostic imaging , Aortic Rupture/surgery , Tomography, X-Ray Computed
11.
Eur J Clin Microbiol Infect Dis ; 42(12): 1537-1541, 2023 Dec.
Article En | MEDLINE | ID: mdl-37882919

Aortitis is a life-threatening, manifestation of chronic Q fever. We report a series of 5 patients with Q fever aortitis who have presented to our hospital in tropical Australia since 2019. All diagnoses were confirmed with polymerase chain reaction (PCR) testing of aortic tissue. Only one had a previous diagnosis of acute Q fever, and none had classical high-risk exposures that might increase clinical suspicion for the infection. All patients underwent surgery: one died and 3 had significant complications. Q fever aortitis may be underdiagnosed; clinicians should consider testing for Coxiella burnetii in people with aortic pathology in endemic areas.


Aortitis , Coxiella burnetii , Q Fever , Humans , Q Fever/complications , Q Fever/diagnosis , Q Fever/epidemiology , Queensland/epidemiology , Aortitis/diagnosis , Aortitis/complications , Coxiella burnetii/genetics , Australia/epidemiology
12.
J Am Coll Cardiol ; 82(11): 1053-1064, 2023 09 12.
Article En | MEDLINE | ID: mdl-37673506

BACKGROUND: Aortitis is a group of disorders characterized by the inflammation of the aorta. The large-vessel vasculitides are the most common causes of aortitis. Aortitis long-term outcomes are not well known. OBJECTIVES: The purpose of this study was to assess the long-term outcome and prognosis of noninfectious surgical thoracic aortitis. METHODS: This was a retrospective multicenter study of 5,666 patients with thoracic aorta surgery including 217 (3.8%) with noninfectious thoracic aortitis (118 clinically isolated aortitis, 57 giant cells arteritis, 21 Takayasu arteritis, and 21 with various systemic autoimmune disorders). Factors associated with vascular complications and a second vascular procedure were assessed by multivariable analysis. RESULTS: Indications for aortic surgery were asymptomatic aneurysm with a critical size (n = 152 [70%]), aortic dissection (n = 28 [13%]), and symptomatic aortic aneurysm (n = 30 [14%]). The 10-year cumulative incidence of vascular complication and second vascular procedure was 82.1% (95% CI: 67.6%-90.6%), and 42.6% (95% CI: 28.4%-56.1%), respectively. Aortic arch aortitis (HR: 2.08; 95% CI: 1.26-3.44; P = 0.005) was independently associated with vascular complications. Descending thoracic aortitis (HR: 2.35; 95% CI: 1.11-4.96; P = 0.031) and aortic dissection (HR: 3.08; 95% CI: 1.61-5.90; P = 0.002) were independently associated with a second vascular procedure, while treatment with statins after aortitis diagnosis (HR: 0.47; 95% CI: 0.24-0.90; P = 0.028) decreased it. After a median follow-up of 3.9 years, 19 (16.1%) clinically isolated aortitis patients developed features of a systemic inflammatory disease and 35 (16%) patients had died. CONCLUSIONS: This multicenter study shows that 82% of noninfectious surgical thoracic aortitis patients will experience a vascular complication within 10 years. We pointed out specific characteristics that identified those at highest risk for subsequent vascular complications and second vascular procedures.


Aortic Dissection , Aortitis , Cardiovascular Diseases , Humans , Aortitis/epidemiology , Prognosis , Aorta , Inflammation , Aortic Dissection/diagnosis , Aortic Dissection/epidemiology , Aortic Dissection/surgery
14.
Clin Nucl Med ; 48(12): 1028-1034, 2023 Dec 01.
Article En | MEDLINE | ID: mdl-37703494

PURPOSE OF THE REPORT: To elucidate the PET/CT findings of pegfilgrastim-induced aortitis (PFIA) and compare them with those of other large-vessel vasculitis. METHODS: We enrolled 45 patients diagnosed with the following: PFIA, n = 8; Takayasu arteritis (TA), n = 12; giant cell arteritis (GCA), n = 6; and immunoglobulin G4-related aortitis (IgG4-A), n = 19. Records of PET/CT performed before treatment initiation were collected. The aorta and its branches were divided into 16 anatomic regions. Presence of abnormal 18 F-FDG uptake in each region was determined and measured. RESULTS: The 18 F-FDG-positive areas of PFIA were distributed in the regions of the ascending aorta to the suprarenal abdominal aorta, cervical branches of the aorta, and external iliac arteries, similar to those of TA. However, TA had a higher proportion of 18 F-FDG-positive areas than PFIA in almost all anatomic regions. These areas of GCA were widespread throughout the entire aorta and the upper and lower limbs, whereas those of IgG4-A were observed from the abdominal aorta to iliac arteries. SUV max , SUV peak , metabolic volume, and total lesion glycolysis were higher in GCA than in PFIA, TA, and IgG4-A. CONCLUSIONS: Pegfilgrastim-induced aortitis distribution on PET/CT was frequently observed in the aorta, cervical branches, and extra iliac arteries. The low proportion of 18 F-FDG-positive areas in PFIA was different from that of TA, GCA, and IgG4-A. These findings may help identify and differentiate various aortitis types in clinical practice.


Aortitis , Giant Cell Arteritis , Takayasu Arteritis , Humans , Fluorodeoxyglucose F18 , Positron Emission Tomography Computed Tomography , Radiopharmaceuticals , Aorta, Abdominal , Immunoglobulin G
15.
Am J Case Rep ; 24: e941070, 2023 Sep 22.
Article En | MEDLINE | ID: mdl-37735866

BACKGROUND Heart failure is caused by coronary artery disease, valvular disease, and arrhythmias and is highly treatable with recent technology. However, the incidence of syphilis is increasing worldwide. This case report describes tertiary cardiovascular syphilis, accompanied by aortic regurgitation, syphilitic aortitis complicated by thrombus of the ascending aorta, and coronary artery occlusion, requiring percutaneous coronary artery intervention. CASE REPORT A 51-year-old Japanese man with no significant medical history was admitted to the hospital for worsening shortness of breath on exertion. On physical examination, there was no edema in either lower leg. Chest X-rays showed an enlarged heart and pulmonary congestion, and echocardiography showed a left ventricular ejection fraction of 18%, with full circumferential wall motion impairment. Heart failure was diagnosed, and the patient was found to have severe coronary artery disease and aortic regurgitation. He underwent percutaneous coronary intervention (PCI) for his coronary artery occlusion and was treated with medications for heart failure. Two months later, his condition improved, and PCI was performed for the revascularization of the remaining coronary artery. After PCI was completed, the patient was evaluated for vasculitis. The aortic wall lesion was likely a result of non-active syphilitic aortitis, and the results of serological tests of syphilis were positive. Therefore, we concluded that the diagnosis was cardiovascular syphilis. CONCLUSIONS This case report has highlighted the need for clinicians to be aware of the cardiovascular findings in syphilis, including syphilitic aortitis, particularly at this time, when the global incidence of syphilis is increasing.


Aortic Valve Insufficiency , Aortitis , Coronary Artery Disease , Coronary Occlusion , Heart Failure , Percutaneous Coronary Intervention , Syphilis, Cardiovascular , Syphilis , Thrombosis , Male , Humans , Middle Aged , Syphilis, Cardiovascular/complications , Syphilis, Cardiovascular/diagnosis , Aortic Valve Insufficiency/diagnosis , Aortic Valve Insufficiency/etiology , Aortitis/diagnosis , Coronary Artery Disease/diagnosis , Stroke Volume , Ventricular Function, Left
16.
Ugeskr Laeger ; 185(35)2023 08 28.
Article Da | MEDLINE | ID: mdl-37767877

In this case report, we present a 70-year-old male who was brought to our hospital with signs of upper gastrointestinal bleeding. The patient was diagnosed with aortitis two and a half months prior. We suspected upper gastrointestinal bleeding, and the patient was taken to the operating room for an acute endoscopy, which showed blood in the oesophagus, ventricle, and duodenum, but no bleeding source. CT angiography showed erosion of aortic aneurism, at the site of known aortitis, with bleeding into the lung and pleura. The patient was transported to the nearest university hospital for thoracic endovascular repair and survived.


Aortic Aneurysm , Aortitis , Male , Humans , Aged , Hematemesis , Hemoptysis , Gastrointestinal Hemorrhage/diagnostic imaging , Gastrointestinal Hemorrhage/etiology , Hospitals, University
17.
Galicia clin ; 84(3): 21-23, jul.-sep. 2023. ilus
Article Es | IBECS | ID: ibc-227720

Introducción: La arteritis de Takayasu se trata de una vasculitis de grandes vasos, crónica y granulomatosa caracterizada por la presencia de estenosis y aneurismas en la aorta y sus ramas principales. Se produce inflamación. vascular que causa dolor. Las pruebas de imagen como el PET-TC han ganado importancia en el diagnóstico. El tratamiento se realiza con inmunosupresores, pudiendo usar fármacos biológicos en casos refractarios. Material y métodos: Estudio descriptivo retrospectivo de 3 casos de enfermedad de Takayasu. Resultados: Presentamos 3 casos atípicos de vasculitis de Takayasu que fueron diagnosticados mediante PET-TC y que evolucionaron de forma diferente, requiriendo 2 de ellos tratamiento con fármacos biológicos. Conclusión: Pruebas de imagen como el PET-TC permiten un diagnóstico temprano y un seguimiento de la enfermedad. Con el uso de fármacos biológicos podemos controlar los casos refractarios. (AU)


Introduction: Takayasu's arteritis is a chronic granulomatous vasculitis of large vessels characterized by the presence of stenosis and aneurysms in the aorta and its mainbranches. Vascular inflammation occurs that causes pain. Imaging tests such as PET-CT have gained importance in diagnosis. The treatment is carried out with immunosuppressants, being able to use biological drugs in refractory cases. Material and methods: Retrospective descriptive study of 3 cases of Takayasu's disease. Results: We present 3 atypical cases of Takayasu vasculitis that were diagnosed by PET-CT and that evolved differently, requiring 2 of them treatment with biological drugs. Conclusion: Imaging tests such as PET-CT allow early diagnosis and monitoring of the disease. With the use of biological drugs we can control refractory cases. (AU)


Humans , Male , Female , Middle Aged , Aged , Takayasu Arteritis/diagnostic imaging , Takayasu Arteritis/drug therapy , Positron Emission Tomography Computed Tomography , Biological Products/therapeutic use , Vasculitis , Aortitis
19.
Autoimmun Rev ; 22(9): 103411, 2023 Sep.
Article En | MEDLINE | ID: mdl-37597603

OBJECTIVES: To investigate the clinicopathologic features of patients with giant cell arteritis (GCA) who had thoracic aorta aneurysm or dissection surgery. METHODS: Patients who had thoracic aorta surgery between January 1, 2000, and December 31, 2021, at the Mayo Clinic, Rochester, Minnesota, were identified with current procedural terminology (CPT) codes. The identified patients were screened for a prior diagnosis of GCA with diagnostic codes and electronic text search. The available medical records of all the patients of interest were manually reviewed. Thoracic aorta tissues obtained during surgery were re-evaluated in detail by pathologists. The clinicopathologic features of these patients were analyzed. Overall observed survival was compared with lifetable rates from the United States population. RESULTS: Of the 4621 patients with a CPT code for thoracic aorta surgery, 49 had a previous diagnosis of GCA. Histopathologic evaluation of the aortic tissue revealed active aortitis in most patients with GCA (40/49, 82%) after a median (IQR) of 6.0 (2.6-10.3) years from GCA diagnosis. All patients were considered in clinical remission at the time of aortic surgery. The overall mortality compared to age and sex-matched general population was significantly increased with a standardized mortality ratio of 1.55 (95% CI, 1.05-2.19). CONCLUSION: Histopathologic evaluation of the thoracic aorta obtained during surgery revealed active aortitis in most patients with GCA despite being considered in clinical remission several years after GCA diagnosis. Chronic, smoldering aortic inflammation likely contributes to the development of aortic aneurysm and dissection in GCA.


Aortitis , Giant Cell Arteritis , Humans , Giant Cell Arteritis/complications , Aortitis/complications , Aorta , Inflammation/complications
20.
RMD Open ; 9(3)2023 08.
Article En | MEDLINE | ID: mdl-37597848

OBJECTIVE: To determine the impact of ultrasound (US) intrinsic limitation to assess aortitis versus FDG-PET/CT in patients with US-proven giant cell arteritis (GCA) and to identify factors associated with aortic involvement. METHODS: Retrospective observational study of patients referred to US fast-track clinics at two academic centres over a 4-year period. Only patients with GCA confirmed by US were included. Temporal arteries (TA) and extracranial arteries US were performed at baseline. FDG-PET/CT was performed according to clinician's criteria. An FDG artery uptake at the aorta higher than liver uptake was considered positive for aortitis. RESULTS: Seventy-two of 186 patients with US-proven GCA underwent an FDG-PET/CT; 29 (40.3%) had a positive FDG-PET/CT and 24 (33.3%) presented aortitis. Only 6 (20.7%) patients with positive FDG-PET/CT had negative US findings of large vessel (LV)-GCA. Among patients with aortitis in FDG-PET/CT, only two (8.3%) had negative US findings of LV-GCA. Patients with aortitis were younger (68.9 vs 81;p<0.001), more frequently females (79.2% vs 39.6%;p=0.002) and had higher platelets count (413.4 vs 311.1;p=0014). Patients with aortitis presented positive TA US less frequently (41.7% vs 83.3%;p<0.001), but more LV US involvement (91.7% vs 41.7%; p<0.001) versus patients without aortitis. None of the patients with aortitis exhibited visual symptoms (0% vs 31.2%;p=0.001). CONCLUSIONS: FDG-PET/CT can detect aortitis in one out of every three patients with US-proven GCA. However, a negative US examination for LV-GCA suggests a low risk of aortitis. Younger and female GCA patients with thrombocytosis, absence of visual manifestations and LV-GCA on US may more frequently present aortitis by FDG-PET/CT.


Aortitis , Giant Cell Arteritis , Humans , Female , Giant Cell Arteritis/complications , Giant Cell Arteritis/diagnosis , Aortitis/diagnostic imaging , Aortitis/etiology , Fluorodeoxyglucose F18 , Positron Emission Tomography Computed Tomography , Ultrasonography
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