Inflammatory diseases of the aorta: Part 1: Non-infectious aortitis

Abstract

Aortitis is a term which encompasses inflammatory changes to the aortic wall from various pathogenic etiologies. Large vessel vasculitis, such as Takayasu arteritis and giant cell arteritis represent the most common entities; however, there is also an association with other rheumatological diseases. Chronic idiopathic periaortitis represents a distinct disease entity and infectious aortitis is a rare but life-threatening disease. Due to the diverse clinical pictures vascular surgeons often face a significant challenge in terms of making an accurate initial diagnosis. Treatment requires an interdisciplinary approach. This article describes the pathogenesis of the various forms of aortitis as well as the diagnostic methods and treatment approaches.

Keywords: Aortic infection; Arteritis; Pathogenesis; Rheumatic diseases; Vasculitis.

Fig. 1

Takayasu arteritis with brachial artery involvement and typical halo (arrow) on color duplex sonography (courtesy of Dr. G. Herzog)

Fig. 2

Widening of the infrarenal aortic wall in a female patient with Takayasu arteritis

Fig. 3

Magnetic resonance imaging showing (a) signal enhancement and (b) marked widening of the subclavian artery wall in a female patient with Takayasu arteritis (arrows)

Fig. 4

Magnetic resonance angiography in the same patient as in Fig. 3 showing inflammatory aneurysms of the axillary arteries (arrows)

Fig. 5

Female patient with Takayasu arteritis and positive positron emission tomography computed tomography showing marked enhancement around the aortic wall

Fig. 6

Giant cell arteritis with the classical finding of painful segmental thickening of the temporal artery (courtesy of Dr. G. Herzog)

Fig. 7

Giant cell arteritis with involvement of the extracranial carotid artery and typical halo (arrow) on color duplex sonography (courtesy of Dr. G. Herzog)