Ascending aortic aneurysm associated with lymphoplasmacytic thoracic aortitis mimics acute type A intramural hematoma – case report
Authors:
R. Zacharovský 1; V. Svitek 1,2; M. Škamlová 3
Authors‘ workplace:
II. klinika kardiochirurgie, Slovenská zdravotnícka univerzita v Bratislave, Stredoslovenský ústav srdcových, a cievnych chorôb, a. s., Banská Bystrica, Slovenská republika
1; Klinika hrudníkovej chirurgie, Jesseniova lekárska fakulta v Martine Univerzity Komenského v Bratislave, Martin, Slovenská republika
2; II. interná klinika, Slovenská zdravotnícka univerzita v Bratislave, Fakultná nemocnica s poliklinikou F. D. Roosevelta, Banská Bystrica, Slovenská republika
3
Published in:
Rozhl. Chir., 2022, roč. 101, č. 4, s. 184-188.
Category:
Case Report
doi:
https://doi.org/10.33699/PIS.2022.101.4.184–188
Overview
Introduction: Lymphoplasmacytic thoracic aortitis is still underrecognized cause of thoracic aortic aneurysm.
Case report: We herein report a case of symptomatic inflammatory ascending aortic aneurysm and pericarditis diagnosed on CT scan as acute type A intramural hematoma. Patient underwent emergency supracoronary ascending aorta replacement with a prosthetic graft. Marked inflammatory thickening of aneurysm wall was the intraoperative finding. Histopathologic examination of the excised aortic tissue showed inflammation with lymphoplasmacytic pattern of aortitis.
Conclusion: This case demonstrates that lymphoplasmacytic aortitis may mimic symptoms and radiological findings of intramural hematoma.
Keywords:
lymphoplasmacytic thoracic aortitis – IgG4 related diseases – inflammatory aortic aneurysm – acute aortic intramural hematoma
Sources
1. Agaimy A, Weyand M, Strecker T. Inflammatory thoracic aortic aneurysm (lymphoplasmacytic thoracic aortitis): a 13-year-experience at a German Heart Center with emphasis on possible role of IgG4. Int J Clin Exp Pathol. 2013;6(9):1713−1722.
2. Park JW, Kim SS, Lee Y-M, et al. CT Findings of immunoglobulin G4 related periaortitis and periarterities: A case report. J Korean Soc Radiol. 2017;77(5):333−338. doi. org/10.3348/jksr.2017.77.5.333.
3. Moore DW, Hansen NJ, DiMaio DJ, et al. The great imitator: IgG4 periaortitis masquerading as an acute aortic syndrome on computed tomographic angiography. Radiology Case Reports 2016;11(4):287−291. doi: 10.1016/j.radcr. 2016.08.006.
4. Nemer DM, Gentrylll JL, Jaber WA, et al. Differentiation of aortitis from type A intramural hematoma. Circulation: CardioVasc Imag. 2019;12:e008934. doi. org/10.1161
5. Torre S, Caramaschi P, Faggian G, et a. Takayasu arteritis mimicking type A intramural hematoma. Ann Thorac Surg. 2017;104:e35−e37. doi: 10.1016/j.athoracsur. 2017.01.121.
6. Oyama-Manabe N, Yabusaki S, Manabe O, et al. IgG4-related cardiovascular disease from the aorta to the coronary arteries: Multidetector CT and PET/CT. RadioGraphics 2018;38:1934–1948. doi: 10.1148/rg.2018180049.
7. Tajima M, Nagai R, Hiroi Y. IgG4-related cardiovascular disorders. Int Heart J. 2014;55(4):287−295. doi: 10.1536/ihj.13- 321.
8. InoueD, Zen Y, Abo H et al. Immunoglobulin G4–related periaortitis and periarteritis: CT findings in 17 patients. Radiology 2011;261(2):625−633. doi: 10.1148/radiol. 11102250.
9. Holmes BJ, Delev NG, Pasternack GR, et al. Novel cause of sudden cardiac death: IgG4-related disease. Circulation 2012;125(23):2956–2957. doi.org/10.1161/CIRCULATIONAHA. 111.061002
10. Kasashima S, Zen Y, Kawashima A, et al. Clinicopathologic study of immunoglobulin G4-related sclerosing disease of the thoracic aorta. J Vasc Surg. 2010;52:1587−1595. doi: 10.1016/j. jvs.2010.06.072.
11. Tioni Ch, Antonutti M, DiNora C, et al. Never forget the aorta: a case report of IgG4-related disease causing aortitis. Eur Heart J. – Case Reports 2018;2:1−5. doi:10.1093/ehjcr/yty111.
12. Laco J, Steiner I, Holubec T et al. Isolated thoracic aortitis: clinicopathological and immunohistochemical study of 11 cases. Cardiovasc Pathol. 2011;20:352−360. doi: 10.1016/j.carpath.2010.09.003.
13. Yabusaki S, Oyama-Manabe N, Manabe O, et al. Characteristics of immunoglobulin G4-related aortitis/periaortitis and periarteritis on fluorodeoxyglucose positron emission tomography/computed tomography co-registered with contrast enhanced computed tomography. EJNMMI Res. 2017;7(1):20. doi: 10.1186/ s13550-017-0268-1.
14. Weiss MA, Aubry MC, Pflederer BR. A Case of IgG4-related aortitis and pericarditis: Diagnostic challenges and natural history. Am J Case Rep. 2018;19:1232−1236. doi: 10.12659/AJCR.910164.
15. Kuranari Y, Tamura R, Mikami S, et al. Severe headache in a patient with meningioma showing extensive dural tail correlates with IgG4-positive plasma cells and eosinophils: A case report and review of literature. Surg Neurology Int. 2018;9:202. doi: 10.4103/sni.sni_231_18.
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