Inflammatory Infrarenal Abdominal Aortic Aneurysm in a Young Woman

Sharif, Muhammad; Soong, Chee V.; Lee, Bernard T.; McCallion, K; Hannon, R.J.

doi:10.1016/j.jemermed.2007.08.057

Cited by 6 publications

(7 citation statements)

References 13 publications

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“…On CT scan, infected aortic aneurysm appears usually as a saccular form aneurysm with nodularity, irregular configuration, or air in the aortic wall [69], in contrast to inflammatory aortic aneurysm, which typically exhibits a fusiform morphology [70], although a saccular morphology is also possible [71]. Calcification within the aneurysm wall may be less common in infected aneurysm [72], although it can be present (Figs.…”

Section: Imagingmentioning

confidence: 99%

Infected aortic aneurysm and inflammatory aortic aneurysm—In search of an optimal differential diagnosis

Ishizaka

Sohmiya

Miyamura

et al. 2012

Journal of Cardiology

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Infected aortic aneurysm and inflammatory aortic aneurysm each account for a minor fraction of the total incidence of aortic aneurysm and are associated with periaortic inflammation. Despite the similarity, infected aortic aneurysm generally shows a more rapid change in clinical condition, leading to a fatal outcome; in addition, delayed diagnosis and misuse of corticosteroid or immunosuppressing drugs may lead to uncontrolled growth of microorganisms. Therefore, it is mandatory that detection of aortic aneurysm is followed by accurate differential diagnosis. In general, infected aortic aneurysm appears usually as a saccular form aneurysm with nodularity, irregular configuration; however, the differential diagnosis may not be easy sometimes for the following reasons: (1) symptoms, such as abdominal and/or back pain and fever, and blood test abnormalities, such as elevated C-reactive protein and enhanced erythrocyte sedimentation rate, are common in infected aortic aneurysm, but they are not found infrequently in inflammatory aortic aneurysm; (2) some inflammatory aortic aneurysms are immunoglobulin (Ig) G4-related, but not all of them; (3) the prevalence of IgG4 positivity in infected aortic aneurysm has not been well investigated; (4) enhanced uptake of 18F-fluorodeoxyglucose (FDG) by 18F-FDG-positron emission tomography may not distinguish between inflammation mediated by autoimmunity and that mediated by microorganism infection. Here we discuss the characteristics of these two forms of aortic aneurysm and the points of which we have to be aware before reaching a final diagnosis.

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Section: Imagingmentioning

confidence: 99%

Infected aortic aneurysm and inflammatory aortic aneurysm—In search of an optimal differential diagnosis

Ishizaka

Sohmiya

Miyamura

et al. 2012

Journal of Cardiology

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“…Sharif et al 2) reported all symptomatic aneurysms larger than 5 cm in diameter should be considered for early surgical repair. Corticosteroids therapy was initially administered to the current patient, because the sizes of the aneurysms were small and the patient was asymptomatic.…”

Section: Discussionmentioning

confidence: 99%

A Case of Double Inflammatory Aneurysms in the Thoracic and Abdominal Aorta Repaired Simultaneously

Kanamitsu¹,

Yamada²

2010

Annals of Vascular Diseases

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Intoroduction Inflammatory aortic aneurysms are commonly found in the infrarenal abdominal aorta and represent 3%-10% of all infrarenal abdominal aortic aneurysms; 1) however, multiple inflammatory aortic aneurysms are rare. This report presents a case of multiple inflammatory aortic aneurysms of the descending thoracic aorta and abdominal aorta. CaseA 54-year-old male who had been experiencing a high fever for a month was admitted to a local hospital for examination. He had no history of medical treatment.Blood tests showed a white blood cell count of 6100/mm 3 , C-reactive protein (CRP) of 15.38 mg/dl. The autoimmune screen was negative and included anti-nuclear antibody, C-ANCA (cytoplasmic antineutrophil cytoplasmic autoantibody), P-ANCA (perinuclear anti-neutrophilic cytoplasmic antibody), rheumatoid factor, IgG, Complement C3, anti-SS-A antibody, and anti-SS-B antibody. The bacterial blood tests and serum endotoxin were also negative. Computed tomography (CT) showed saccular aneurysms in the descending thoracic aorta and infrarenal abdominal aorta. The walls of the aneurysms were thickened and enhanced by intravenous contrast which suggested an inflammatory change (Fig. 1, 2).Mycotic aneurysms were suspected and the patient was treated with antibiotics. However, the CRP did not improve and the fever continued. So the patient was transferred to this hospital for further examination and treatment.The aneurysms were diagnosed to be inflammatory aneurysms and the patient was treated with prednisolone because the bacterial blood tests were negative, and CT showed no evidence of intramural air or fluid collection suggestive of an infective etiology. The CRP improved to 1.12 mg/dl in a week which also supported the diagnosis of inflammatory aneurysms. However, CT scan after improvement of CRP showed the descending thoracic aorta aneurysm diameter had grown from 30 mm to 32 mm A 54-year-old male who had been experiencing a high fever for a month was admitted to a local hospital for examination. Computed tomography revealed saccular aneurysms in the descending thoracic aorta and infrarenal abdominal aorta. The walls of the aneurysms were thickened and enhanced by intravenous contrast which suggested the inflammatory change. He was transferred to this hospital and underwent graft replacement of both the descending thoracic aorta and the abdominal aorta simultaneously. Simultaneous surgery should be considered in patients presenting with multiple inflammatory aneurysms, since inflammatory aneurysms have a risk of demonstrating rapid enlargement.

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“…Although a variable degree of inflammation is seen in all atherosclerotic aneurysms (Rijbroek et al, 1994), rare cases of inflammatory abdominal aortic aneurysm have been diagnosed mainly in elderly patients with only few cases being diagnosed in young patients (Sharif et al, 2008). The characteristics of inflammatory abdominal aortic aneurysm are the following: thick aortic wall containing a variable mononuclear infiltrate, periaortitis, with possible association of perianeurysmal fibrosis or involvement of ureters and duodenum (Sharif et al, 2008). It is currently considered that inflammatory abdominal aortic aneurysm, associated with variable perianeurysmal fibrosis, and idiopathic retroperitoneal fibrosis are all components of the chronic periaortitis spectrum (Jois et al, 2004).…”

Section: Atherosclerosis Role In the Aortic Aneurysm Pathogenesismentioning

confidence: 99%

“…It is currently considered that inflammatory abdominal aortic aneurysm, associated with variable perianeurysmal fibrosis, and idiopathic retroperitoneal fibrosis are all components of the chronic periaortitis spectrum (Jois et al, 2004). In 19% of patients this process is part of a systemic autoimmune disorder but sometimes the autoimmune diseases cannot be identified (Sharif et al, 2008). A possible reaction to the antigens released from the atherosclerotic plaques has been also considered (Sharif et al, 2008).…”

Section: Atherosclerosis Role In the Aortic Aneurysm Pathogenesismentioning

confidence: 99%

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Etiology and Pathogenesis of Aortic Aneurysm

Amălinei¹,

Căruntu²

2013

Aortic Aneurysm - Recent Advances

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Histological examination demonstrates that the pathophysiological processes in aortic aneurysm involve all layers of the aortic wall in a variable proportion. Although the aortic aneurysm morphological characteristics have been well-recognized, the mechanism which elicits its formation is incompletely understood. However, it is generally accepted that an aneurysm results from an association of genetic predisposition, stresses within the aortic wall, proteolytic degradation of the structural components, and/or inflammation and autoimmune response. A review of the relevant scientific publications, concerning the etiology, pathogeny, histology, and molecular markers is presented in this chapter. These data provide valuable mechanistic insight into the pathogenesis of aortic aneurysm, reveal diagnostic markers, and identify new therapeutic targets.

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Inflammatory Infrarenal Abdominal Aortic Aneurysm in a Young Woman

Cited by 6 publications

References 13 publications

Infected aortic aneurysm and inflammatory aortic aneurysm—In search of an optimal differential diagnosis

Infected aortic aneurysm and inflammatory aortic aneurysm—In search of an optimal differential diagnosis

A Case of Double Inflammatory Aneurysms in the Thoracic and Abdominal Aorta Repaired Simultaneously

Etiology and Pathogenesis of Aortic Aneurysm

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