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Review
. 2016;21(Suppl 2):87-93.
doi: 10.1007/s00772-016-0142-x. Epub 2016 Jun 13.

Inflammatory diseases of the aorta: Part 2: Infectious aortitis

I Töpel  1 , N Zorger  2 , M Steinbauer  1
Affiliations
Review

Inflammatory diseases of the aorta: Part 2: Infectious aortitis

I Töpel et al. Gefasschirurgie. 2016.

Abstract
in English, German

Infectious aortitis is a rare but life-threatening disease. Due to impending local and systemic complications, prompt diagnosis and initiation of effective causal treatment are essential for patient survival. Differentiating infectious aortitis from other aortic diseases, in particular non-infectious aortitis, is of great importance. This article discusses the various causes, diagnostic tools, and therapeutic strategies for infectious aortitis.

Infektiöse Aortitiden stellen ein sehr seltenes, aber lebensbedrohliches Krankheitsbild dar. Auf Grund der drohenden lokalen und systemischen Komplikationen dieser Erkrankungen sind eine schnelle Diagnose und die Einleitung einer konsequenten kausalen Therapie essenziell für das Überleben des Patienten. Die Abgrenzung von anderen Erkrankungen der Aorta, insbesondere den nicht-infektiösen Aortitiden kommt eine große Bedeutung zu. In diesem Beitrag sollen die verschiedenen Auslöser, die diagnostischen Möglichkeiten und die Behandlungsstrategien bei infektiösen Aortitiden diskutiert werden.

Keywords: Aortic diseases; Aortitis; Arteritis; Infection; Vasculitis.

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Figures

Fig. 1
Fig. 1
Echocardiography showing vegetations (arrow) in endocarditis following aortic valve repair using a bioprosthesis (courtesy of Dr. Frank Heißenhuber, Regensburg)
Fig. 2
Fig. 2
Abdominal computed tomography following intravenous contrast medium, arterial phase, coronal reconstruction. (a) Mycotic aneurysm of the aorta immediately below the branch of the left renal artery (arrow), (b) abdominal computed tomography following intravenous contrast medium, axial view, arterial phase. Visualization of the mycotic aneurysm with a breach in aortic wall calcification. Inflammatory wall thickening and patent inflammatory periaortic soft tissue border (arrow)
Fig. 3
Fig. 3
(a) Fast low angle shot (FLASH) magnetic resonance imaging, abdominal (T1 post-contrast medium), coronal view. Partially thrombosed, infectious false aneurysm of the abdominal aorta (arrow). (b) Magnetic resonance angiography of the abdominal aorta in the same patient. The extent of the finding as well as its inflammatory cause are distinctly underestimated in the maximum intensity projection (MIP) only reconstruction. Additional axial and coronal sequences are required in the diagnostic work-up for aortitis, in addition to magnetic resonance imaging assessment of morphology
Fig. 4
Fig. 4
(a). Native thoracic computer tomography, axial view, showing mycotic aneurysm (arrow) of the descending aorta in direct contact to spondylodiscitis of the 4th thoracic vertebra. Additional inflammatory osteolysis of the affected vertebra. Pleural effusion left side. (b) Positron emission tomography fusion image, sagittal reconstruction, high activity in spondylodiscitis projecting to the 3rd and 4th thoracic vertebrae (arrow)
Fig. 5
Fig. 5
a Magnetic resonance imaging, abdominal (T2-weighted), axial view, marked inflammatory thickening of the abdominal aortic wall (arrow), perihepatic and perisplenic free fluid. b Significantly increased signal intensity in lumbar vertebrae 1 and 2 and intervertebral disc consistent with spondylodiscitis and prevertebral cuff of inflammatory soft tissue. c Inflammatory aneurysmal dilatation of the infrarenal dorsal aortic wall (arrow) in direct connection with the vertebral body
See this image and copyright information in PMC

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