Aortitis overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]
Overview
Aortitis is the inflammation of the aortic wall. The disorder is potentially life-threatening and rare. It is reported that there are only 1-3 new cases of aortitis per year per million people in the United States and Europe[1]. Aortitis is found in a wide range of ages spanning from 10 to 40 years of age.
Classification
Aortitis may be classified according to the cause into 2 groups: inflammatory and infectious[2][3].
Pathophysiology
Aortitis is inflammation or infection of the aortic wall.[3] On microscopic histopathological analysis, extensive intimal and adventitial fibrosis and scarring with resultant luminal narrowing are characteristic findings of aortitis due to Takayasu arteritis. Extensive medial inflammation and necrosis are characteristic findings on microscopic histopathological analysis of aortitis due to giant cell arteritis.[3] The majority of cases of infectious aortitis are due to bacteria seeding through a segment of the aortic wall with existing pathology via the vasa vasorum.
Causes
Life threatening causes of aortitis include bacteremia and mycotic aneurysm. Common causes of aortitis include ankylosing spondylitis, giant cell arteritis, Takayasu arteritis, and syphilis.
Differential Diagnosis
Aortitis must be differentiated from aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer.[3]
Natural History, Complications, and Prognosis
If left untreated, infectious aortitis is associated with a high rate of aortic rupture and subsequent mortality. Aortitis due to either giant cell arteritis or Takayasu arteritis has a high rate of recurrence despite therapy.[3] Common complications of aortitis include: aortic aneurysm, aortic rupture, aortic dissection, thrombus formation in the aortic lumen, and hypertension. The prognosis of infectious aortitis is generally poor. Prognosis of isolated aortitis and aortitis associated with rheumatic diseases is generally good with prompt diagnosis.[4]
Diagnosis
History and Symptoms
Symptoms of aortitis include back pain, fever, abdominal pain, chest pain, shortness of breath, and fatigue.
Physical Examination
Common physical examination findings of aortitis include abnormal heart sounds, hypertension or hypotension, a difference in blood pressure between both arms, and either reduced or absent pulses.[5]
Treatment
Management appears to include the following treatment priorities; stop the inflammation, treat complications, prevent and monitor for re-occurrence.
Prognosis
References
- ↑
- ↑ Bronze MS, Shirwany A, Corbett C, Schaberg DR (1999). "Infectious aortitis: an uncommon manifestation of infection with Streptococcus pneumoniae". The American Journal of Medicine. 107 (6): 627–30. PMID 10651596. Unknown parameter
|month=ignored (help) - ↑ 3.0 3.1 3.2 3.3 3.4 Gornik HL, Creager MA (2008). "Aortitis". Circulation. 117 (23): 3039–51. doi:10.1161/CIRCULATIONAHA.107.760686. PMC 2759760. PMID 18541754. Unknown parameter
|month=ignored (help) - ↑ "Isolated aortitis".Accessed on September 14th, 2015
- ↑ Accessed on September 11th, 2015 "Isolated Aortitis" Check
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