Emphysematous aortitis: report of two cases and CT imaging findings

Abstract

Emphysematous aortitis is a rare condition that manifests through the presence of air within or surrounding the inflamed aorta. Aortic inflammation may result from either an infective or a non-infective cause. Recognition of this rare condition is important as the resultant clinical deterioration may be rapid and lead to inevitable death. Cross-sectional imaging, with its relatively wide availability, proves an important tool in the diagnosis and subsequent management of this condition. We report two such cases encountered in our centre, with particular focus on the imaging findings on CT.

Emphysematous Aortitis due to Klebsiella Pneumoniae in a Patient With Poorly Controlled Diabetes Mellitus

“…2,3 EA is a rare but serious inflammatory condition of the aorta with a nonspecific clinical presentation associated with high morbidity and mortality. [2][3][4][5][6] The condition is characterized by a localized collection of gas and purulent exudate at the aortic wall. 1,3 A few cases of EA have previously been reported; however, no known cases have been reported in the literature due to Klebsiella pneumoniae (K pneumoniae).…”

“…Under normal circumstances, the aortic intima is highly resistant to infectious pathogens; however, certain risk factors, such as diabetes mellitus (DM), atherosclerotic disease, preexisting aneurysm, cystic medial necrosis, vascular malformation, presence of medical devices, surgery, or impaired immunity can alter the integrity of the aortic intimal layer and predispose the aortic intima to infection. 1,[4][5][6][7] Bacteria are the most common causative organisms that can infect the aorta, especially Staphy-lococcus, Enterococcus, Streptococcus, Salmonella, and spirochete Treponema pallidum (syphilis). 1,2,4,8 The site of the primary infection remains unclear in some patients.…”

“…1,[4][5][6][7] Bacteria are the most common causative organisms that can infect the aorta, especially Staphy-lococcus, Enterococcus, Streptococcus, Salmonella, and spirochete Treponema pallidum (syphilis). 1,2,4,8 The site of the primary infection remains unclear in some patients. 2,3,5,6 Infection of the aorta can arise by several mechanisms: direct extension of a local infection to an existing intimal injury or atherosclerotic plaque (the most common mechanism), septic embolism from endocarditis, direct bacterial inoculation from traumatic contamination, contiguous infection extending to the aorta wall, or a distant source of bacteremia.…”

“…The diagnosis should be considered in patients with atherosclerosis, fever, abdominal pain, and leukocytosis. 2,[4][5][6][7][8] The differential diagnosis for EA includes (1) noninfective causes of aortitis, including rheumatoid arthritis and systemic lupus erythematosus; (2) tuberculous aortitis; (3) syphilitic aortitis; and (4) idiopathic isolated aortitis. Establishing an early diagnosis of infectious aortitis is extremely important because this condition is associated with a high rate of morbidity and mortality secondary to aortic rupture.…”

“…Establishing an early diagnosis of infectious aortitis is extremely important because this condition is associated with a high rate of morbidity and mortality secondary to aortic rupture. [2][3][4][5][6][7] Imaging is critical for a reliable and quick diagnosis of acute aortic pathology. Noninvasive cross-sectional imaging modalities, such as contrast-enhanced computed tomography (CT), magnetic resonance imaging, nuclear medicine, or positron emission tomography, are used for both the initial diagnosis and follow-up of aortitis.…”