Aortitis overview

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Overview

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Classification

Pathophysiology

Causes

Differentiating Aortitis from other Diseases

Epidemiology and Demographics

Risk Factors

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Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

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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. 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[1][2].

Pathophysiology

Aortitis is inflammation or infection of the aortic wall.[2] 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.[2] 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.[2]

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.[2] 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.[3]

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.[4]

Laboratory Findings

Laboratory findings consistent with the diagnosis of aortitis include elevated erythrocyte sedimentation rate and C-reactive protein.<ref>"Aortitis".Accessed on September 11th, 2015</ref

Treatment

Management appears to include the following treatment priorities; stop the inflammation, treat complications, prevent and monitor for re-occurrence.

Prognosis

References

  1. 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)
  2. 2.0 2.1 2.2 2.3 2.4 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)
  3. "Isolated aortitis".Accessed on September 14th, 2015
  4. Accessed on September 11th, 2015 "Isolated Aortitis" Check |url= value (help).


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