The Differential Diagnosis of Two Cases of Chronic Periaortitis. (28th August 2013)

• Record Type: Journal Article
• Authors: Kato, Takao; Minamino, Eri; Nakane, Eisaku; Miyamoto, Shoichi; Izumi, Toshiaki; Haruna, Tetsuya; Nohara, Ryuji; Inoko, Moriaki
• Other Names: Bastarrika G. Academic Editor.; Bhargava R. Academic Editor.; Strohm O. Academic Editor.
• Is Part Of: Case reports in radiology. Volume 2013(2013)
• Publication Date: 2013-08-28
• Subjects: Radiology -- Periodicals; Radiology -- Case studies -- Periodicals; Medical radiology -- Periodicals; Radiology; Radiology; Medical radiology; Periodicals; Electronic journals; Case studies; Periodicals; 616.0757
• DOI: 10.1155/2013/282067
• Languages: English
• ISSNs: 2090-6862

Abstract

Abstract : The imaging features of chronic periaortitis resemble those of infected aneurysms. Two illustrative cases of chronic periaortitis, in which the etiologies were caused by IgG4-related disease, are presented. The first case involved a 68-year-old man who presented with vague discomfort in his lower abdomen. The second case was a 42-year-old man who presented with a fever of 38°C and persistent, vague chest discomfort. Both cases demonstrated an increased amount of connective tissue around the aorta in computed tomography images and low intensity in the T2-weighed sequence and high intensity in the diffusion-weighed sequence, suggesting the presence of inflammation, in the magnetic resonance imaging. Negative blood cultures, elevated IgG4 levels, and pathological findings confirmed the diagnosis as chronic periaortitis due to IgG4-related disease. This is a newly recognized syndrome of unknown etiology, characterized by a fibroinflammatory condition, tumefactive lesions, and a dense lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells. Both cases were successfully treated with corticosteroids. Infected aneurysms need to be carefully differentiated from this syndrome in view of the similar imaging features.