Periaortitis: gadolinium-enhanced magnetic resonance imaging and response to therapy in four patients.
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.
Mitnick
Hal
H
Department of Medicine, New York University School of Medicine, New York, NY 10016, USA. hjmit@aol.com
Jacobowitz
Glenn
G
Krinsky
Glen
G
Eberle
Mark
M
Rosenzweig
Barry
B
Willis
David
D
Rockman
Caron
C
Riles
Thomas
T
D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001161:Arteriosclerosis / Q000150:complications; D001379:Azathioprine / Q000627:therapeutic use; D003287:Contrast Media / Q000494:pharmacology; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D012185:Retroperitoneal Fibrosis / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D012216:Rheumatic Diseases / Q000150:complications; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D003287:Contrast Media; D007166:Immunosuppressive Agents; D019786:Gadolinium DTPA; D001379:Azathioprine; D011241:Prednisone; D008727:Methotrexate