Abstract
In this review article, we focused on the imaging features and diagnosis of infected aortic aneurysms and inflammatory diseases involving the aorta. The imaging features of other inflammatory diseases involving the aorta resemble those of infected aneurysms. In particular, chronic periaortitis is a manifestation of immunoglobulin G4 (IgG4)-related disease, which is a newly recognized syndrome of unknown etiology that has attracted much attention. IgG4-related disease is characterized by a fibroinflammatory condition with a dense lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells. Considering their similar imaging features, infected aneurysms should be carefully differentiated from chronic periaortitis. The treatment options for these 2 potential diagnoses are completely different and consist of either corticosteroids or antibiotics. Medical history, severity (high or low grade) of fever, physical examination, clinical course (rapidly or slowly progressive), repeated blood cultures, multiple imaging modalities, and elevated IgG4 levels in addition to pathological findings would be useful in obtaining a differential diagnosis in patients suspected of having either of the aforementioned conditions.
Highlights
Infected aortic aneurysm was first reported by Osler [1] in 1885, andit has received increasing attention since owing to its rapidly progressive clinical course and fatal outcome [2]
The true prevalence of infected aneurysm is unknown, the disease accounts for 0.7-2.6% of cases of aortic aneurysm [3]
We focus on the diagnosis, especially imaging features, of infected aneurysms and diseases related to inflammation of the aorta that require differentiation from infected aneurysms, such as chronic periaortitis and collagen vascular diseases
Summary
Infected aortic aneurysm was first reported by Osler [1] in 1885, andit has received increasing attention since owing to its rapidly progressive clinical course and fatal outcome [2]. Which is a finding that is consistent with our personal experience. The number of reports of infected aneurysms (mycotic aneurysms) in Pubmed search are increasing [4,5]. The reasons for such increases include: 1) the increased numbers of aged patients, who are at greater risk of atherosclerosis; 2) improved Computed Tomography (CT) imaging and Magnetic Resonance Imaging (MRI) techniques; and 3) greater awareness of the disease. We focus on the diagnosis, especially imaging features, of infected aneurysms and diseases related to inflammation of the aorta that require differentiation from infected aneurysms, such as chronic periaortitis (one of the presentations of IgG4-related disease) and collagen vascular diseases
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