Type:
Educational Exhibit
Keywords:
Inflammation, Infection, Diagnostic procedure, MR-Angiography, CT-Angiography, CT, Arteries / Aorta
Authors:
P. Hernandez Mateo, M. Domínguez Fraga, A. VIDAL GONZÁLEZ, I. de la Pedraja Gómez-Ceballos, A. Bustos; Madrid/ES
DOI:
10.1594/ecr2018/C-2755
Background
Aortitis is a subtipe of vasculitis that involves histologically inflammation of the aortic wall.
This is a specific condition of the wide spectrum of vasculitis that show different etiologies,
pathophysiologies,
clinical manifestations and prognoses.
Aortic wall inflammation may be caused by an infectious etiology but it is more often due to a non-infectious origin.
Theres is a broad classification of aortitis and different clinical conditions associated as it is shown in table 1 (Fig.1).
Fig. 1
Clinical manifestations depend on the etiology of vasculitis but are often vague and nonspecific.
A patient with a non-infectious great vessel vasculitis may present with symptoms of arterial insufficiency in the case of Takayasu arteritis or a typical headache in the case of giant cell arteritis.
Nevertheless a patient with an infectious aortitis may present with fever and back-pain as in the case of aortitis secondary to different pathogens such as Salmonella,
tuberculosis and syphilis among others.
Imaging Techniques
There is no specific protocol or examination for the assessment of potential vasculitis and imaging is only one of many other tools available for the diagnosis.
The main purpose of imaging exams is to assess vessel wall morphology and sometimes the grade of inflammation,
exclude alternative diagnosis and analize the evolution of the disease.
Usually protocols used for initial assessment and follow-up at CT,
PET/TC or MRI are similar to facilitate and guarantee a correct comparison.
The Gold standard to assess aortitis and great-vessell vasculitis is CT.
Other techniques as MRI,
PET/TC or PET/MR are increasingly been used due to their capacity to evaluate the activity of the aortic wall.
Conventional angiography as it is an invasive technique with possible complications it is more commonly used for therapeutical procedures.
Imaging characteristics,
hallmarks and possible contraindications of the different techniques are showed in table 2 (Fig.2).
Fig. 2