Nonaneurysmal Suppurative Aortitis

Bardin, Joshua A.; Collins, Geoffrey M.; Devin, Joseph B.; Halasz, Nicholas A.

doi:10.1001/archsurg.1981.01380190082019

Cited by 34 publications

(13 citation statements)

References 8 publications

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“…Nonaneurysmal infectious aortitis is more difficult to diagnose on imaging than MA, given the lack of aortic dilation, but even so may be complicated by rupture (43,44). A more recent case report described achieving an elusive diagnosis of infectious nonaneurysmal infectious aortitis by using broad-range polymerase chain reaction and DNA sequencing, which allowed for identification of the microbial species despite negative blood cultures (45).…”

Section: Nonaneurysmal Infectious Aortitismentioning

confidence: 99%

Inflammatory and infectious aortic diseases

Deipolyi

Czaplicki

Öklü

2018

Cardiovasc. Diagn. Ther.

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Aortitis is aortic inflammation, which can be due to inflammatory or infectious diseases. Left undiagnosed, aortitis can lead to aneurysm formation and rupture, in addition to ischemic compromise of major organs. Infectious aortic diseases include mycotic aneurysm and graft infection; the most common inflammatory diseases are Takayasu's and giant cell arteritis. We review the epidemiology, etiology, presentation and diagnosis, and treatment of these entities. S62infectious extravascular source adjacent the arterial wall (16,17). Bacteria may seed the arterial wall injury either from bacteremia or septic emboli (18). Typically, infection initiates in a nidus such as in an ulcerated atherosclerotic plaque or in the vasa vasorum (12). The vasa vasorum is thought to be key in the pathogenesis of MA formation; due to its small lumen size and slower flow, it is more susceptible to bacterial colonization (19,20). The vasa vasorum is more pronounced in larger arteries, which may explain why the aorta is the most common site of MA formation. DiagnosisEarly diagnosis and rapid triage for intervention is key to reducing mortality from MA (21,22). However, diagnosis is challenging given the low prevalence and nonspecific symptoms. Clinical signs may include fever and laboratory abnormalities including elevated erythrocyte sedimentation rate and leukocytosis (23). Bacteremia is common, though cultures may be negative, particularly after antibiotics have been given. Symptoms include pain or a pulsatile mass (23). In the setting of pre-existing endocarditis, prior invasive procedures, intravenous drug use or immunocompromise should increase suspicion (8,24).Non-invasive cross-sectional imaging is essential in the diagnosis of MA. Computed tomography angiography (CTA) has arisen as the imaging modality of choice owing to its excellent resolution allowing for three-dimensional reconstruction and its rapid acquisition; magnetic resonance imaging (MRI) may also be used (25)(26)(27). Certain features may distinguish MA from non-infected aneurysms, including serial imaging which may reveal rapid progression typical of infected aneurysms. Other characteristic features include contrast-enhancement and a saccular outpouching configuration, whereas non-infected atherosclerotic aneurysms tend to be fusiform (28). Saccular configuration may also suggest imminent rupture, alerting the need for further urgent diagnostic workup. Other features include irregularity of the arterial wall and peri-aortic gas, edema, mass or stranding (28). MAs also tend to have higher uptake on FDG-PET imaging of 4.5 SUV max or more compared with non-infected aneurysms (29). FDG-PET boasts high sensitivity and its potentially high false-positive rate can be improved with simultaneous CT. Treatment and prognosisDue to its elusive presentation, MA is often difficult to treat because of delayed diagnosis. Rapid diagnosis and treatment is key, as aortic MA is associated with 15-50% mortality (7)(8)(9)24). No randomized trials are available to guide manage...

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Section: Nonaneurysmal Infectious Aortitismentioning

confidence: 99%

Inflammatory and infectious aortic diseases

Deipolyi

Czaplicki

Öklü

2018

Cardiovasc. Diagn. Ther.

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“…1 Aortitis also should be suspected among older patients with atherosclerosis and sepsis with bacteremia from a typical organism such as the Salmonella species. 1,59,60 In such cases, immediate cross-sectional aortic imaging (computed tomography angiography [CTA] or magnetic resonance angiography [MRA]) should be performed to exclude the possibility of infectious aortitis. Establishing the diagnosis of infectious aortitis or mycotic aortic aneurysm early is critical because this condition is associated with a high rate of rupture and subsequent mortality if left untreated.…”

Section: Infectious Aortitismentioning

confidence: 99%

“…[95][96][97][98] Despite aggressive therapy, mortality associated with infectious aortitis remains high in reported series, largely owing to a high rate of aortic rupture. 1,59,61,62,93,94 Although no clinical studies have established the optimal duration of antibiotic therapy for aortitis, a treatment course of at least 6 to 12 weeks after surgical debridement and clearance of blood cultures is generally recommended, with a longer course reserved for patients with immunosuppressive disorders. 1…”

Section: Infectious Aortitismentioning

confidence: 99%

Aortitis

2008

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“…Blood and stool cultures eventually grew out Salmonella enteritidis. Aortic resection was performed during surgery and no aneurysm was found (22). Both cases illustrate the difficulty in making this diagnosis, as the initial clinical presentation is often vague and non-specific.…”

mentioning

confidence: 93%

“…The review of the literature yielded only a few cases describing infectious aortitis in the absence of aneurysm or rupture (22,23). The incidence of this entity is not known.…”

mentioning

confidence: 99%