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Cardiovascular risk factors and acute-phase response in idiopathic ascending aortitis: a case control study
Vaidehi R Chowdhary, Cynthia S Crowson, Kimberly P Liang, Clement J Michet, Dylan V Miller, Kenneth J Warrington, Eric L Matteson
Arthritis Research & Therapy , 2009, DOI: 10.1186/ar2633
Abstract: We conducted a case control study of 50 patients who were age-matched with two control subjects with non-inflammatory ascending aortic aneurysms. We examined whether the prevalences of gender, hypertension, hyperlipidemia, diabetes mellitus, smoking, family history of any aortic aneurysms, and elevated inflammatory markers differed between cases and controls.The mean age of cases was 71.6 ± 8.9 years and that of controls was 71.1 ± 8.9 years. We found female gender (odds ratio [OR] 2.41, 95% confidence interval [CI] 1.20 to 4.85; P = 0.014) and active smoking (OR 3.37, 95% CI 1.12 to 10.08; P = 0.03) to be associated with idiopathic aortitis. The association with smoking persisted after adjustment for gender (OR 3.24, 95% CI 1.05 to 9.96; P = 0.04). There was a trend toward lower prevalence of diabetes mellitus in cases (OR 0.39, 95% CI 0.11 to 1.43; P = 0.16) but no difference in prevalences of other risk factors. The median pre-operative erythrocyte sedimentation rate (ESR) was 20 mm/hour in cases (n = 13) and 9 mm/hour in controls (n = 22). The median pre-operative C-reactive protein (CRP) levels were 12 mg/L in cases (n = 8) and 3 mg/L in controls (n = 6) (normal: <8 mg/L). A higher proportion of cases versus controls had elevations in ESR (38% versus 9%; P = 0.075) and CRP (62% versus 0%; P = 0.031).Gender and smoking may interact in complex mechanisms with immune and proteolytic pathways in older, less distensible thoracic aortas. Elevated acute-phase reactants as a marker of systemic inflammation may be present in some patients.Aneurysms of the thoracic aorta are rare and occur with an incidence of 5.9 per 100,000 [1]. They are caused by weakening of the aortic wall from hypertension, heritable disorders like Marfan syndrome, bicuspid valve disease, and inflammatory and infectious processes. Among the systemic inflammatory diseases, thoracic aneurysms and aortitis occur in giant cell arteritis (GCA), Takayasu arteritis, anti-neutrophil cytoplasmic antibody (A
Idiopathic aortitis: an underrecognized vasculitis
Nicolò Pipitone, Carlo Salvarani
Arthritis Research & Therapy , 2011, DOI: 10.1186/ar3389
Abstract: Aortitis is a general term for a spectrum of disorders characterized by inflammation of the aortic wall. A variety of infectious and non-infectious diseases can be complicated by aortitis; in addition, isolated idiopathic aortitis - usually involving the thoracic aorta - has also been described.In the previous issue of Arthritis Research & Therapy, Schmidt and colleagues report on the prevalence and predictors of biopsy-proven aortitis in a 12-year nation-wide Danish population-based study [1]. Aortic aneurysms and dissections were the most common (76.2%) indications for surgery. The prevalence of aortitis among 1,210 resected thoracic aorta samples was 6.1%, with nearly three-quarters of cases being idiopathic and one-quarter being associated with diseases known to cause aortitis. Only 14% of aortitis cases were linked to giant cell arteritis (GCA), and none to Takayasu arteritis (TA). Identified risk factors for aortitis included advanced age, a history of connective tissue disease, diabetes mellitus, and heart valve pathology.This study is unique in being population-based. Nevertheless, the prevalence of idiopathic aortitis found is remarkably similar to that reported by similar studies from surgical centers, in which idiopathic aortitis made up 4.3 to 8.4% of all aortitis cases [2-4]. Such a close concordance comes as no surprise, because the indications for surgery mentioned in Schmidt and colleagues' study [1] largely overlap with those from other centers [2-4]. A common bias to this study and previous studies from surgical centers is a skew towards reporting aortitis cases complicated by aortic aneurysms and, to a lesser extent, dissections requiring surgical repair. This bias implies that aortitis characterized by asymptomatic vessel wall thickening, lumen stenosis, or small aneurysms is likely to have been underestimated. Stated otherwise, idiopathic aortitis may be both more common and less severe than it would appear from the results of this study.Systemi
Syphilitic aortitis: Rearing of the ugly head  [cached]
Vaideeswar Pradeep
Indian Journal of Pathology and Microbiology , 2010,
Abstract: Context: Syphilitic aortitis has been relegated to the category of rare cardiovascular disease or a "medical curiosity" in the west. The same situation may not exist in developing countries due to the stigmata that continue to remain attached to sexually-transmitted diseases in general. Aims: To study the prevalence of syphilitic aortitis among autopsied non-atherosclerotic aortic diseases encountered in a span of 15 years. Settings and Design: Retrospective, autopsy-based study. Materials and Methods: Among 187 cases of non-atherosclerotic diseases of the aorta, 44 had been diagnosed as syphilitic aortitis on the basis of the pathological features and serology. The demographic details and modes of clinical presentation were retrieved from the health records. Depending on the presence of complicating lesions, the cases were classified as uncomplicated or complicated aortitis. Results: The 44 cases of syphilitic aortitis formed 23.5 % of the non-atherosclerotic aortic diseases. They were predominantly seen in males in the fifth decade, who often presented with valvular regurgitation, aneurysmal disease or myocardial ischemia; 13.6 % of patients were asymptomatic. Blood VDRL results were available in 19 patients; 84.2 % were positive. Concomitant involvement of the ascending, transverse and descending thoracic was seen in 45.5 % of cases. None had uncomplicated aortitis. Complications in the form of aortic regurgitation (72.7 %), coronary ostial stenosis (59 %) and aneurysms (59 %) frequently coexisted. Thirty-five aneurysms were present in 59 %, chiefly involving the aorta. Conclusions: We found syphilitic aortitis to be a common cause of aortitis at autopsy. Diagnosis should be made with the help of characteristic pathological features correlated to the clinical context and appropriate serological tests.
Insights into imaging of aortitis
Diana E. Litmanovich,Afra Y ld r m,Alexander A. Bankier
Insights into Imaging , 2012, DOI: 10.1007/s13244-012-0192-x
Abstract: Contrast-enhanced CT, MRI and PET-CT are used for both the initial diagnosis and follow-up of aortitis.
Microbial Aortitis with Aneurysm Formation  [PDF]
Richard Raghoo, Marleen J. Noeverman, Ronald Hoekstra, Rob Geelkerken, Goos D. Laverman
World Journal of Cardiovascular Surgery (WJCS) , 2014, DOI: 10.4236/wjcs.2014.411026
Abstract: A 68-year-old man who presented with periodic fever and generalized weakness was diagnosed with Enterococcus faecalis bacteraemia from an infected abdominal aneurysm. The aneurysm was new: aortic dilatation was absent a year before. In such patients the diagnosis “microbial aortitis” is more appropriate than “mycotic aneurysm”. We discuss the pathophysiology, epidemiology, prognosis and treatment of this condition.
Clostridium septicum Aortitis and Cecal Adenocarcinoma
Brian Moseley,Nicola W. Mwirigi,Juan Bowen
Case Reports in Medicine , 2010, DOI: 10.1155/2010/121728
Abstract: Clostridium septicum aortitis is a rare infection that is highly associated with underlying malignancy. We present a case of an 82-year-old male diagnosed with both C. septicum aortitis and a high-grade cecal tubulovillous adenoma. The patient was offered aortic resection; however, he opted for only suppressive antibiotic therapy and a right hemicolectomy with ileocolonic anastomosis. He ultimately passed away 75 days following admission. The authors report on the connection between C. septicum aortitis and malignancy. The authors also discuss the need for prompt treatment with antibiotics once the infection is identified and the consideration of aortic resection given the risk of aneurysmal change with aortic dissection or rupture.
Primary aortoenteric fistula related to septic aortitis
Tozzi, Fábio Lambertini;Silva, Erasmo Sim?o da;Campos, Fernando;Fagundes Neto, Henrique Oscar de Azevedo;Lucon, Marcos;Lupinacci, Renato Micelli;
Sao Paulo Medical Journal , 2001, DOI: 10.1590/S1516-31802001000400008
Abstract: context: primary aortoenteric fistulas usually result from erosion of the bowel wall due to an associated abdominal aortic aneurysm. a few patients have been described with other etiologies such as pseudoaneurysm originating from septic aortitis caused by salmonella. objective: to present a rare clinical case of pseudoaneurysm caused by septic aortitis that evolved into an aortoenteric fistula. case report: a 65-year-old woman was admitted with salmonella bacteremia that evolved to septic aortitis. an aortic pseudoaneurysm secondary to the aortitis had eroded the transition between duodenum and jejunum, and an aortoenteric fistula was formed. in the operating room, the affected aorta and intestinal area were excised and an intestine-to-intestine anastomosis was performed. the aorta was sutured and an axillofemoral bypass was carried out. in the intensive care unit, the patient had a cardiac arrest that evolved to death.
Syphilitic Aortitis Mimicking Takayasu’s Arteritis  [PDF]
Anna Sophia P?rings, Bernd Salzberger, Lothar Veits, Boris Ehrenstein, Wolfgang Hartung, Martin Fleck
Case Reports in Clinical Medicine (CRCM) , 2014, DOI: 10.4236/crcm.2014.38100
Abstract:

SIR, Syphilis is a sexually-transmitted infectious disease caused by the bacteria Treponemapallidum. A characteristic manifestation of the third stage is arteritis of the aorta, which leads to necrosis and loss of tissue. Here, we report on a 48-year-old woman admitted with suspected Takayasu’s arteritis (TA) due to localized inflammation confined to the aortic root and valve, which could be diagnosed as syphilitic aortitis.

Salmonella aortitis treated with endovascular aortic repair: a case report  [cached]
Strahm Carol,Lederer Heidi,Schwarz Esther I,Bachli Esther B
Journal of Medical Case Reports , 2012, DOI: 10.1186/1752-1947-6-243
Abstract: Introduction Salmonella is a typical cause of aortitis, which is associated with high morbidity and mortality. In infrarenal disease, besides open surgery, endovascular aortic repair as an alternative treatment has been reported. To the best of our knowledge, we report the first successful endovascular aortic repair documented by necropsy to date. Case presentation A 67-year-old Caucasian man presented with low back pain, fever and positive blood cultures for Salmonella Enteritidis. A computed tomography scan showed an enlargement and intramural hematoma of the infrarenal aortic wall; a Salmonella aortitis was suspected and antimicrobial therapy initiated. Because of substantial comorbidities, endovascular aortic repair was favored over open surgery; postoperatively the antibiotic treatment was continued for 12 months. Post-mortem there were neither macroscopic nor microscopic signs of aortitis or graft infection. Conclusions We could demonstrate by necropsy that endovascular aortic repair of infrarenal aortitis with prolonged pre- and postinterventional antibiotic therapy for 12 months was a minimally invasive alternative and should be considered in selected clinically stable patients with substantial co-morbidities.
Aortitis requiring aortic repair associated with glaucoma, thyroiditis, glaucoma, and neuropathy: case report
Claudia St?llberger, Marion Avanzini, Aileen Hanafin, Ramona Sanani, Georg Wieselthaler, Nikolaus Wick, Günther Bayer, Günther M?lzer, Josef Finsterer
Journal of Cardiothoracic Surgery , 2011, DOI: 10.1186/1749-8090-6-74
Abstract: Aortitis of the ascending aorta may be due to infectious and non-infectious causes, comprising several systemic disorders [1,2]. Aortitis, associated with glaucoma, thyroiditis, pericarditis, pleural effusion and neuropathy with prompt clinical response to glucocorticoids has not been described so far.A 63-year old HIV-negative Iranian female was hospitalized in May 2004 because of fatigue, undulating fever, night sweats, and weight loss starting 8 weeks before. In 1991 and 1992 she had undergone bilateral iridectomy because of glaucoma. She has had 2 uneventful pregnancies and wan through menopause at the age of 52. Twenty-seven years ago, an intrauterine device (IUD) had been implanted but never been removed. She smoked 20 cigarettes/day.Physical examination was normal, the blood-pressure was 130/75 mmHg bilaterally. Blood tests showed normochromic anaemia (haemoglobin 10.1 g/dl, normal >12.0), elevated CRP levels (12.3 mg/dl, normal <0.6) and an increased erytrocyte sedimentation rate (110 mm, normal <20). Blood cultures remained negative. Stool culture did not grow any pathogens. Antinuclear antibodies, their subsets and antineutrophilic cytoplasmic antibodies were negative. Antibodies against smooth muscle cells were repeatedly positive. Serologic tests for Treponema pallidum, Brucella abortus, Brucella melitensis, Francisella tularensis, Yersinia enterocolitica, Yersinia pseudotuberculosis, Bartonella henselae, Borrelia burgdorferi, Coxiella burnetti, Ehrlichia, Leptospira, Mycoplasma pneumoniae and Ureaplasma urealyticum were negative. Agglutination reaction with Salmonella-H unspecified was 1: 320 and with Salmonella-HD 1: 1280. Chlamydia SP-IgA and IgG Antibodies were repeatedly positive. HLA-B27 testing was negative, while an HLA-DR4 15(2) allele was assessed. Computed-tomography (CT) and magnetic-resonance-imaging (MRI) of the chest showed an ectatic ascending aorta (50 mm) with diffusely thickened walls (Figure 1). She received an empirical antibiotic th
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