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Periaortitis: Gadolinium-enhanced Magnetic Resonance Imaging and Response to Therapy in Four Patients

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Annals of Vascular Surgery

Abstract

The objective of this study was to define clinical and imaging characteristics of periaortitis prior to and after therapy with immunosuppressive drugs. Four consecutive patients with periaortitis (two secondary to atherosclerosis and two with rheumatic diseases) were studied with contrast-enhanced CT and magnetic resonance angiography (MRA), rheumatologic serologies, and acute-phase reactants. All were treated with corticosteroids and two patients received immunosuppressive agents. Patients were followed with serial MRA scans, CT scans, and clinical exams. Prior to treatment, all patients demonstrated a rind of periaortic tissue, which was enhanced with both contrast-enhanced CT as well as gadolinium-enhanced MRA. Clinical symptoms resolved and rind contracture occurred in all cases following therapy. Enhancement of the rind persisted despite the clinical improvement in all patients. No patient developed an aortic aneurysm or retroperitoneal fibrosis during the follow-up period. Corticosteroid/immunosuppressive treatment was continued for an average of 41 months. At 62 months of total follow-up, there has been no recurrence of periaortitis by clinical and/or radiologic exam. Treatment of periaortitis with corticosteroids and immunosuppression therapy leads to resolution of clinical symptoms and radiologic contracture of the periaortic rind. Patients responded to therapy without developing progressive fibrosis or aneurysm. MRA allows safe and repetitive imaging of periaortitis and provides excellent definition of lumenal abnormalities including plaque rupture.

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References

  1. PM Higgins et al. (1988) ArticleTitleNon-operative management of retroperitoneal fibrosis. Br J Surg 75 573–577 Occurrence Handle1:STN:280:BieB1c7ovVA%3D Occurrence Handle3293696

    CAS  PubMed  Google Scholar 

  2. G Leseche et al. (1992) ArticleTitleDiagnosis and management of 17 consecutive patients with inflammatory abdominal aortic aneurysm. Am J Surg 164 39–44 Occurrence Handle1:STN:280:By2A38fgvFQ%3D Occurrence Handle1626604

    CAS  PubMed  Google Scholar 

  3. DI Walker et al. (1972) ArticleTitleInflammatory aneurysms of the abdominal aorta. Br J Surg 59 609–614 Occurrence Handle1:STN:280:CSyD3c7htlQ%3D Occurrence Handle5069199

    CAS  PubMed  Google Scholar 

  4. AH Boontje JJ van den Dungen C Blanksma (1990) ArticleTitleInflammatory abdominal aortic aneurysms. J Cardiovasc Surg (Torino) 31 611–616 Occurrence Handle1:STN:280:By6D3srlslU%3D

    CAS  Google Scholar 

  5. HJ Leu (1990) ArticleTitleInflammatory abdominal aortic aneurysms: a disease entity? Histological analysis of 60 cases of inflammatory aortic aneurysms of unknown aetiology. Virchows Arch A Pathol Anat Histopathol 417 427–433 Occurrence Handle1:STN:280:By6D2cbktFM%3D Occurrence Handle1978436

    CAS  PubMed  Google Scholar 

  6. AGM Stella MD Faggioli et al. (1991) ArticleTitleInflammatory abdominal aortic aneurysms: Does an early stage exist? J Cardiovasc Surg (Torino) 32 732–736 Occurrence Handle1:STN:280:By2D1M7jslc%3D

    CAS  Google Scholar 

  7. MJ Mitchinson (1984) ArticleTitleChronic periaortitis and periarteritis. Histopathology 8 589–600 Occurrence Handle1:STN:280:BiqD3cris1Y%3D Occurrence Handle6479901

    CAS  PubMed  Google Scholar 

  8. DV Parums (1990) ArticleTitleThe spectrum of chronic periaortitis. Histopathology 16 423–431 Occurrence Handle1:STN:280:By%2BB1MbitlI%3D Occurrence Handle2193863

    CAS  PubMed  Google Scholar 

  9. NJ Lance DJ Levinson (1991) ArticleTitleAortitis and periaortic fibrosis. J Rheumatol 18 1095–1099 Occurrence Handle1:STN:280:By2D3Mrgslw%3D Occurrence Handle1920315

    CAS  PubMed  Google Scholar 

  10. M Kuwana et al. (1992) ArticleTitleRetroperitoneal fibrosis associated with aortitis. Arthritis Rheum 35 1245–1247 Occurrence Handle1:STN:280:ByyD3sfptV0%3D Occurrence Handle1418010

    CAS  PubMed  Google Scholar 

  11. OM Faye-Petersen et al. (1996) ArticleTitleLymphoplasmacytic aortitis and acute aortic dissection. An uncommon association. Arch Pathol Lab Med 120 402–404 Occurrence Handle1:STN:280:BymB3c7kslI%3D Occurrence Handle8619757

    CAS  PubMed  Google Scholar 

  12. GS Gilkeson NB Allen (1996) ArticleTitleRetroperitoneal fibrosis. A true connective tissue disease. Rheum Dis Clin North Am 22 23–38 Occurrence Handle1:STN:280:ByiD28zhvFE%3D Occurrence Handle8907063

    CAS  PubMed  Google Scholar 

  13. L Dalla-Palma et al. (1981) ArticleTitleComputed tomography in the diagnosis of retroperitoneal fibrosis. Urol Radiol 3 77–83 Occurrence Handle1:STN:280:Bi2D1crptFA%3D Occurrence Handle7314324

    CAS  PubMed  Google Scholar 

  14. AA Ramirez et al. (1982) ArticleTitleCAT scans of inflammatory aneurysms: a new technique for preoperative diagnosis. Surgery 91 390–393 Occurrence Handle1:STN:280:Bi2C2MzltVY%3D Occurrence Handle7064094

    CAS  PubMed  Google Scholar 

  15. AK Dixon MJ Mitchinson T Sherwood (1984) ArticleTitleComputed tomographic observations in periaortitis: a hypothesis. Clin Radiol 35 39–42 Occurrence Handle6690179

    PubMed  Google Scholar 

  16. SA Mulligan et al. (1989) ArticleTitleCT and MR imaging in the evaluation of retroperitoneal fibrosis. J Comput Assist Tomogr 13 277–281

    Google Scholar 

  17. WT Yuh et al. (1989) ArticleTitleMagnetic resonance imaging in the diagnosis and follow-up of idiopathic retroperitoneal fibrosis. J Urol 141 602–605 Occurrence Handle1:STN:280:BiaC2c7ptFI%3D Occurrence Handle2918601

    CAS  PubMed  Google Scholar 

  18. AP Brooks (1990) ArticleTitleComputed tomography of idiopathic retroperitoneal fibrosis (‘periaortitis’): variants, variations, patterns and pitfalls. Clin Radiol 42 75–79 Occurrence Handle1:STN:280:By%2BA28jktVA%3D Occurrence Handle2203584

    CAS  PubMed  Google Scholar 

  19. JK Lee HS Glazer (1990) ArticleTitleControversy in the MR imaging appearance of fibrosis. Radiology 177 21–22 Occurrence Handle1:STN:280:By%2BA2sfgslM%3D Occurrence Handle2399319

    CAS  PubMed  Google Scholar 

  20. ES Amis Jr (1991) ArticleTitleRetroperitoneal fibrosis. AJR Am J Roentgenol 157 321–329

    Google Scholar 

  21. EA Jones MK Alexander (1966) ArticleTitleIdiopathic retroperitoneal fibrosis associated with an arteritis. Ann Rheum Dis 25 356–360 Occurrence Handle1:STN:280:CCmC2szjs1w%3D Occurrence Handle5947581

    CAS  PubMed  Google Scholar 

  22. MC Pereira et al. (1981) ArticleTitleInflammatory aneurysm of the abdominal aorta with coronary arteritis. Arch Pathol Lab Med 105 678–679 Occurrence Handle1:STN:280:Bi2D28jivFw%3D Occurrence Handle6895458

    CAS  PubMed  Google Scholar 

  23. GO Littlejohn EC Keystone (1981) ArticleTitleThe association of retroperitoneal fibrosis with systemic vasculitis and HLA-B27: a case report and review of the literature. J Rheumatol 8 665–669 Occurrence Handle1:STN:280:Bi2D2MrltFc%3D Occurrence Handle6975379

    CAS  PubMed  Google Scholar 

  24. A Vaglio D Corradi L Manenti et al. (2003) ArticleTitleEvidence of autoimmunity in chronic periaortitis: a prospective study. Am J Med 114 454–464 Occurrence Handle10.1016/S0002-9343(03)00056-1 Occurrence Handle12727578

    Article  PubMed  Google Scholar 

  25. L Arrive et al. (1989) ArticleTitleMalignant versus nonmalignant retroperitoneal fibrosis: differentiation with MR imaging. Radiology 172 139–143 Occurrence Handle1:STN:280:BiaB1Mjjslc%3D Occurrence Handle2740497

    CAS  PubMed  Google Scholar 

  26. MR Prince et al. (1995) ArticleTitleBreath-hold gadolinium-enhanced MR angiography of the abdominal aorta and its major branches. Radiology 197 785–792 Occurrence Handle7480757

    PubMed  Google Scholar 

  27. AP Brooks RH Reznek JA Webb (1990) ArticleTitleMagnetic resonance imaging in idiopathic retroperitoneal fibrosis: measurement of T1 relaxation time. Br J Radiol 63 IssueID755 842–844 Occurrence Handle1:STN:280:By6D2s%2Fhs1I%3D Occurrence Handle2252975

    CAS  PubMed  Google Scholar 

  28. A Takagi et al. (1986) ArticleTitleSurgical treatment of non-specific inflammatory arterial aneurysms. J Cardiovasc Surg (Torino) 27 117–124 Occurrence Handle1:STN:280:BimC2c%2FjtlI%3D

    CAS  Google Scholar 

  29. AR Hedges PG Bentley (1986) ArticleTitleResection of inflammatory aneurysm after steroid therapy. Br J Surg 73 374

    Google Scholar 

  30. CP Clark D Vanderpool JT Preskitt (1991) ArticleTitleThe response of retroperitoneal fibrosis to tamoxifen. Surgery 109 502–506 Occurrence Handle1:STN:280:By6C1c%2FotFc%3D Occurrence Handle2008655

    CAS  PubMed  Google Scholar 

  31. JR Benson M Baum (1993) ArticleTitleTamoxifen for retroperitoneal fibrosis. Lancet 341 IssueID8848 836 Occurrence Handle10.1016/0140-6736(93)90618-Q Occurrence Handle1:STN:280:ByyB3cvmtFY%3D

    Article  CAS  Google Scholar 

  32. CJ Schwartz M.J. . (1962) ArticleTitleCellular infiltration of the human arterial adventitia associated with atheromatous plaques. Circulation 26 73–78

    Google Scholar 

  33. HD Feiner et al. (1984) ArticleTitleInflammatory abdominal aortic aneurysm: report of six cases. Hum Pathol 15 454–459 Occurrence Handle1:STN:280:BiuB3M%2FlsV0%3D Occurrence Handle6724566

    CAS  PubMed  Google Scholar 

  34. DV Parums DL Brown MJ Mitchinson (1990) ArticleTitleSerum antibodies to oxidized low-density lipoprotein and ceroid in chronic periaortitis. Arch Pathol Lab Med 114 383–387 Occurrence Handle1:STN:280:By%2BB3M%2FosFY%3D Occurrence Handle2322097

    CAS  PubMed  Google Scholar 

  35. BM Osborne et al. (1987) ArticleTitleIdiopathic retroperitoneal fibrosis (sclerosing retroperitonitis). Hum Pathol 18 735–739 Occurrence Handle1:STN:280:BiiB2cfnt1E%3D Occurrence Handle3297996

    CAS  PubMed  Google Scholar 

  36. AL Ramshaw DV Parums (1990) ArticleTitleImmunohistochemical characterization of inflammatory cells associated with advanced atherosclerosis. Histopathology 17 543–552 Occurrence Handle1:STN:280:By6C28bktlw%3D Occurrence Handle2076887

    CAS  PubMed  Google Scholar 

  37. AL Ramshaw DE Roskell DV Parums (1994) ArticleTitleCytokine gene expression in aortic adventitial inflammation associated with advanced atherosclerosis (chronic periaortitis). J Clin Pathol 47 721–722 Occurrence Handle1:STN:280:ByqD2M7mtlw%3D Occurrence Handle7962625

    CAS  PubMed  Google Scholar 

  38. AL Ramshaw DV Parums (1994) ArticleTitleThe distribution of adhesion molecules in chronic periaortitis. Histopathology 24 23–32 Occurrence Handle1:STN:280:ByuC1MzhsV0%3D Occurrence Handle7511559

    CAS  PubMed  Google Scholar 

  39. JT Grayston et al. (1993) ArticleTitle Chlamydia pneumoniae, strain TWAR and atherosclerosis. Eur Heart J 14 IssueIDsuppl K 66–71 Occurrence Handle8131792

    PubMed  Google Scholar 

  40. AM Fink KA Miles EP Wraight (1994) ArticleTitleIndium-111 labeled leucocyte uptake in aortitis. Clin Radiol 49 863–866 Occurrence Handle1:STN:280:ByqC38bjtFI%3D Occurrence Handle7828392

    CAS  PubMed  Google Scholar 

  41. D Blockmans et al. (2000) ArticleTitlePositron emission tomography in giant cell arteritis and polymyalgia rheumatica: evidence for inflammation of the aortic arch. Am J Med 108 246–249 Occurrence Handle10.1016/S0002-9343(99)00424-6 Occurrence Handle1:STN:280:DC%2BD3c7os1Ghuw%3D%3D Occurrence Handle10723979

    Article  CAS  PubMed  Google Scholar 

  42. I Derdelinckx et al. (2000) ArticleTitlePositron emission tomography scan in the diagnosis and follow-up of aortitis of the thoracic aorta. Acta Cardiol 55 193–195 Occurrence Handle1:STN:280:DC%2BD3M%2FivVOksw%3D%3D Occurrence Handle10902045

    CAS  PubMed  Google Scholar 

  43. A Turlakow et al. (2001) ArticleTitleFludeoxyglucose positron emission tomography in the diagnosis of giant cell arteritis. Arch Intern Med 161 1003–1007 Occurrence Handle10.1001/archinte.161.7.1003 Occurrence Handle1:STN:280:DC%2BD3M3jslGrtw%3D%3D Occurrence Handle11295964

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Medicine, New York University School of Medicine, New York, NY, USA

    Hal Mitnick MD, Mark Eberle MD & Barry Rosenzweig MD

  2. Department of Surgery, New York University School of Medicine, New York, NY, USA

    Glenn Jacobowitz MD, David Willis MD, Caron Rockman MD & Thomas Riles MD

  3. Department of Radiology, New York University School of Medicine, New York, NY, USA

    Glen Krinsky MD

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  1. Hal Mitnick MD
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  2. Glenn Jacobowitz MD
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  3. Glen Krinsky MD
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  4. Mark Eberle MD
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Correspondence to Hal Mitnick MD.

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Mitnick, H., Jacobowitz, G., Krinsky, G. et al. Periaortitis: Gadolinium-enhanced Magnetic Resonance Imaging and Response to Therapy in Four Patients . Ann Vasc Surg 18, 100–107 (2004). https://doi.org/10.1007/s10016-003-0060-8

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  • DOI: https://doi.org/10.1007/s10016-003-0060-8

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