Aortitis pathophysiology: Difference between revisions

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==Overview==
==Overview==
Aortitis is a term used to describe inflammation of the aortic wall.<ref name="pmid18541754">{{cite journal| author=Gornik HL, Creager MA| title=Aortitis. | journal=Circulation | year= 2008 | volume= 117 | issue= 23 | pages= 3039-51 | pmid=18541754 | doi=10.1161/CIRCULATIONAHA.107.760686 | pmc=PMC2759760 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18541754  }} </ref>  
Aortitis is [[inflammation]] or [[infection]] of the aortic wall.<ref name="pmid18541754">{{cite journal| author=Gornik HL, Creager MA| title=Aortitis. | journal=Circulation | year= 2008 | volume= 117 | issue= 23 | pages= 3039-51 | pmid=18541754 | doi=10.1161/CIRCULATIONAHA.107.760686 | pmc=PMC2759760 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18541754  }} </ref> On gross pathology, characteristic findings of aortitis include a tree-bark appearance and scarring of the aortic media and destruction of the elastic lamina.<ref>{{Cite web | title =Aortitis | url =http://librepathology.org/wiki/index.php/Vasculitides#Aortitis }}</ref> 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]].<ref name="pmid18541754">{{cite journal| author=Gornik HL, Creager MA| title=Aortitis. | journal=Circulation | year= 2008 | volume= 117 | issue= 23 | pages= 3039-51 | pmid=18541754 | doi=10.1161/CIRCULATIONAHA.107.760686 | pmc=PMC2759760 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18541754  }} </ref> 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]].


==Pathophysiology==
==Pathophysiology==
===Inflammatory Aortitis===
===Gross Pathology===
Giant cell arteritis and Takayasu arteritis are associated with inflammatory cellular infiltrate of the aortic media, adventitia, and vasa vasorum. Eventually scarring of the aortic media and destruction of the elastic lamina may occur.  On microscopic histopathological analysis, granuloma formation, a tree-bark appearance, and multinucleated giant cells may be seen in either Takayasu arteritis or Giant cell arteritis.  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 is a characteristic finding on microscopic histopathological analysis of aortitis due to giant cell arteritis.<ref name="pmid18541754">{{cite journal| author=Gornik HL, Creager MA| title=Aortitis. | journal=Circulation | year= 2008 | volume= 117 | issue= 23 | pages= 3039-51 | pmid=18541754 | doi=10.1161/CIRCULATIONAHA.107.760686 | pmc=PMC2759760 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18541754 }} </ref>
On gross pathology, characteristic findings of aortitis include:<ref>{{Cite web | title =Aortitis | url =http://librepathology.org/wiki/index.php/Vasculitides#Aortitis }}</ref>
*A tree-bark appearance
*Scarring of the aortic media and destruction of the elastic lamina
===Microscopic Pathology===
On microscopic histopathological analysis, characteristic findings of aortitis include:<ref name="pmid18541754">{{cite journal| author=Gornik HL, Creager MA| title=Aortitis. | journal=Circulation | year= 2008 | volume= 117 | issue= 23 | pages= 3039-51 | pmid=18541754 | doi=10.1161/CIRCULATIONAHA.107.760686 | pmc=PMC2759760 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18541754}} </ref>
 
{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align=center
|valign=top|
|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Cause of Aortitis}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Microscopic Histopathologic Features}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
:[[Takayasu arteritis]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Extensive intimal and adventitial [[fibrosis]] and [[scarring]]
*Luminal narrowing
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:[[Giant cell arteritis]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Extensive medial [[inflammation]]
*Medial [[necrosis]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:[[Takayasu arteritis]] and [[Giant cell arteritis]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Inflammatory cellular infiltrate of the aortic media, adventitia, and vasa vasorum 
*[[Granuloma]] formation
*[[Multinucleated giant cells]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:Syphilitic aortitis
| style="padding: 5px 5px; background: #F5F5F5;" |
*Inflammatory infiltrate of the medial and adventitial vasa vasorum
*Medial [[necrosis]]
*Wrinkled appearance of the intima
*Small microgummas within the media
|-
|}


===Infectious Aortitis===
===Infectious Aortitis===
The majority of cases of bacterial aortitis are due to bacteria seeding through a segment of the aortic wall with existing pathology via the vasa vasorum. Tuberculous aortitis occurs due to miliary spread or as a result of direct seeding of the thoracic aorta from adjacent infected tissues.  Syphilitic aortitis most commonly involves the ascending aorta. The classic histopathological finding in syphilitic aneursym is a “tree barking” appearance of the aortic intima.<ref name="pmid18541754">{{cite journal| author=Gornik HL, Creager MA| title=Aortitis. | journal=Circulation | year= 2008 | volume= 117 | issue= 23 | pages= 3039-51 | pmid=18541754 | doi=10.1161/CIRCULATIONAHA.107.760686 | pmc=PMC2759760 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18541754  }} </ref> Inflammatory involvement of tertiary syphilis begins at the adventitia of the [[aortic arch]] which progressively causes [[obliterative endarteritis]] of the vasa vasorum. This leads to narrowing of the lumen of the vasa vasorum, causing ischemic injury of the medial aortic arch and then finally loss of elastic support and dilation of the vessel.<ref>{{Cite web | title =Syphilitic aortitis | url = https://en.wikipedia.org/wiki/Syphilitic_aortitis}}</ref>
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. [[Tuberculous]] aortitis occurs due to miliary spread or as a result of direct seeding of the [[thoracic aorta]] from adjacent infected tissues.  Syphilitic aortitis most commonly involves the [[ascending aorta]]. Inflammatory involvement of tertiary syphilis begins at the adventitia of the [[aortic arch]] which progressively causes obliterative endarteritis of the vasa vasorum. This leads to narrowing of the lumen of the vasa vasorum, causing ischemic injury of the medial [[aortic arch]] and then finally loss of elastic support and dilation of the vessel.<ref>{{Cite web | title =Syphilitic aortitis | url = https://en.wikipedia.org/wiki/Syphilitic_aortitis}}</ref>


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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Latest revision as of 20:27, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2] Associate Editor(s)-in-Chief: Maliha Shakil, M.D. [3]

Overview

Aortitis is inflammation or infection of the aortic wall.[1] On gross pathology, characteristic findings of aortitis include a tree-bark appearance and scarring of the aortic media and destruction of the elastic lamina.[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.[1] 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.

Pathophysiology

Gross Pathology

On gross pathology, characteristic findings of aortitis include:[3]

  • A tree-bark appearance
  • Scarring of the aortic media and destruction of the elastic lamina

Microscopic Pathology

On microscopic histopathological analysis, characteristic findings of aortitis include:[1]

Cause of Aortitis Microscopic Histopathologic Features
Takayasu arteritis
Giant cell arteritis
Takayasu arteritis and Giant cell arteritis
Syphilitic aortitis
  • Inflammatory infiltrate of the medial and adventitial vasa vasorum
  • Medial necrosis
  • Wrinkled appearance of the intima
  • Small microgummas within the media

Infectious Aortitis

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. Tuberculous aortitis occurs due to miliary spread or as a result of direct seeding of the thoracic aorta from adjacent infected tissues. Syphilitic aortitis most commonly involves the ascending aorta. Inflammatory involvement of tertiary syphilis begins at the adventitia of the aortic arch which progressively causes obliterative endarteritis of the vasa vasorum. This leads to narrowing of the lumen of the vasa vasorum, causing ischemic injury of the medial aortic arch and then finally loss of elastic support and dilation of the vessel.[4]

References

  1. ↑ 1.0 1.1 1.2 Gornik HL, Creager MA (2008). "Aortitis". Circulation. 117 (23): 3039–51. doi:10.1161/CIRCULATIONAHA.107.760686. PMC 2759760. PMID 18541754.
  2. ↑ "Aortitis".
  3. ↑ "Aortitis".
  4. ↑ "Syphilitic aortitis".


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