Aortic aneurysm associated with rheumatoid aortitis

Abstract

A 59-year-old female, presented with dry cough, burning micturition with urgency and frequency for 2 months. She was known to have hypertension, hypothyroidism and rheumatoid arthritis for the past 30 years; and was receiving oral methotrexate 20 mg per-week. She also had complianed of low backache for 2 months. No phenotypic features of Marfans/Ehler Danlos were evident. Cardiovascular system examination was unremarkable. Chest radiograph showed mediastinal widening with a large fusiform descending thoracic aortic aneurysm. Computed tomography (CT) of the chest showed subpleural fibrosis and fusiform dilatation of the aorta from the origin till the supracoeliac aorta. CT aortogram revealed an irregular non-enhancing wall thickening and calcification of the aorta with fusiform dilatation (4.5 cm × 4.6 cm in the ascending aorta and 4.4 cm × 4.3 cm in the distal descending aorta). The patient did not have any features of giant cell arteritis (GCA)/Takayasu's arteritis; Venereal Disease Research Laboratory (VDRL) test was negative. The patient was diagnosed to have aortic regurgitation due to long standing rheumatoid arthritis and was referred to the department of cardiothoracic and vascular surgery for further management.