Aortitis masquerading as intramural hematoma: When to observe, when to operate? A case report.
Aortitis
aortic imaging
intramural hematoma
Journal
Journal of cardiac surgery
ISSN: 1540-8191
Titre abrégé: J Card Surg
Pays: United States
ID NLM: 8908809
Informations de publication
Date de publication:
Apr 2021
Apr 2021
Historique:
revised:
07
01
2021
received:
20
10
2020
accepted:
08
01
2021
pubmed:
28
1
2021
medline:
15
5
2021
entrez:
27
1
2021
Statut:
ppublish
Résumé
Radiologic evidence of aortic disease is not always consistent with the diagnosis. With a lack of accompanying symptoms or with an atypical presentation, diagnosis, and management of aortic pathology rely greatly on imaging techniques. We report the case of a 58-year-old female who presented with incidental radiographic findings consistent with a type A aortic intramural hematoma and a vague left-sided chest discomfort. After follow-up, imaging was consistent with disease progression and hematoma expansion; the affected segment was resected and pathology reported lymphoplasmacytic aortitis as the underlying etiology of the imaging findings rather than an intramural hematoma. The patient lacked symptoms or serology consistent with the rheumatologic disease, and the postoperative course was uneventful. The management of a suspected ascending intramural hematoma is controversial, especially when the patient presents with atypical signs and symptoms. Features of disease progression may warrant urgent surgical intervention.
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
1554-1556Informations de copyright
© 2021 Wiley Periodicals LLC.
Références
Harris KM, Braverman AC, Eagle KA, et al. Acute aortic intramural hematoma: an analysis from the International Registry of Acute Aortic Dissection. Circulation. 2012;126(11 suppl 1):S91-S96.
Alomari IB, Hamirani YS, Madera G, Tabe C, Akhtar N, Raizada V. Aortic intramural hematoma and its complications. Circulation. 2014;129(6):711-716.
Hata M, Hata H, Sezai A, Yoshitake I, Wakui S, Shiono M. Optimal treatment strategy for type A acute aortic dissection with intramural hematoma. J Thorac Cardiovasc Surg. 2014;147(1):307-311.
Kaji S, Akasaka T, Horibata Y. Long-term prognosis of patients with type A aortic intramural hematoma. ACC Curr J Rev. 2003;12(1):16.
Nemer DM, Gentry JL, Jaber WA, Jellis CL. Differentiation of aortitis from type A intramural hematoma: use of positron emission tomography in multimodality imaging. Circ Cardiovasc Imaging. 2019;12(6):e008934.
Selvaraj A, Francis N, Harky A, Goli G, Bashir M. Imaging modalities in the management of aortitis. Indian J Thorac and Cardiovasc Surg. 2019;35(S2):67-71.
Harky A, Fok M, Howard C, Bashir M. Current controversies in large-vessel inflammatory vasculitis and thoracic aortic aneurysm disease. Int J Angiol. 2019;28(4):215-225.