The radiologic diagnosis of inflammatory aneurysms

An inflammatory aneurysm is defined as a nonbacterial special type of atherosclerotic aneurysm. The macroscopic characteristics are: a porcelaneous appearance, excessive thickening of the aortic wall, and perianeurysmal adhesions. Chronic inflammatory infiltrations, which are localized in the adventitia, can be found via microscopy. Six of forty-three patients with abdominal aortic aneurysms were found to have an inflammatory aneurysm at operation. In a retrospective study, we examined the sonographic, computed tomographic and angiographic appearance of inflammatory aneurysms. Only with computed tomography can thickening of the aneurysmal wall be demonstrated; angiography does not have this capacity and can only find an inflammatory aneurysm in particular cases.     

Infectious or Noninfectious? Ruptured, Thrombosed Inflammatory Aortic Aneurysm with Spondylolysis

Osteolysis of vertebrae due to inflammatory aortic aneurysm is rarely observed. However, it is estimated that up to 10 % of infectious aneurysms coexist with bone tissue destruction, most commonly the vertebrae. Inflammatory aneurysms with no identified infection factor, along with infiltration of adjacent muscle and in particular extensive destruction of bone tissue have rarely been described in the literature. A case of inflammatory aneurysm with posterior wall rupture and inflammatory infiltration of the iliopsoas muscle and spine, together with extensive vertebral body destruction, is presented. The aneurysm was successfully treated with endovascular aneurysm repair EVAR.     

CT of inflammatory abdominal aortic aneurysm: development from an uncomplicated atherosclerotic aneurysm.

The etiology and natural history of inflammatory abdominal aortic aneurysm are poorly understood. We report a case of inflammatory abdominal aortic aneurysm that developed from an uncomplicated aneurysm over a period of 6 1/2 months.     

Endovascular repair of inflammatory aortic aneurysms: long-term results

OBJECTIVE: Our objective was to report the long-term follow-up results of endovascular aneurysm repair of inflammatory aortic aneurysms. CONCLUSION: Endovascular aneurysm repair of inflammatory aortic aneurysms excludes the aneurysm and seems to reduce the size of the aneurysmal sac and the extent of periaortic fibrosis with acceptable periinterventional and long-term morbidity.     

A unique proposed etiology for inferior mesenteric artery aneurysm: A case report

The etiology of large artery aneurysms has long been established as secondary to atherosclerotic disease and degenerative changes in the vessel walls. Less common, are aneurysms of the visceral arteries; the splanchnic and renal arteries. Rarer yet, are inferior mesenteric artery aneurysms, accounting for approximately 1% of visceral artery aneurysms. While causes range from inflammatory to congenital disease, a proposed etiology of proximal, solitary inferior mesenteric artery aneurysms, is correlated to the “jet disorder phenomenon,” first described in a 1990 case report by Sugrue, and Hederman. This paradigm states that aneurysm formation may occur secondary to celiac and superior mesenteric artery occlusion, causing increased, and turbulent arterial flow distally. We present a case that demonstrates a small inferior mesenteric artery aneurysm without findings of celiac or superior mesenteric artery stenosis or occlusion. This patient did, however, have a large thrombosed common hepatic artery aneurysm which may serve as an alternate cause of jet disorder phenomenon. The findings in this case offers support for focused screening of proximal arterial vasculature when an inferior mesenteric artery aneurysm is encountered.     

Selective bronchial arteriography in children.

Twenty nine selective bronchial arteriographies were carried out in 25 children. In 5 cases the findings were normal. In 1 case an aneurysm of the bronchial artery was demonstrated as the source of the bleeding into the bronchus in a case of Rendu-Weber-Osler syndrome. In 1 case a plasmocytoma and in another one a congenital haemangiomatous network with many anastomoses to the pulmonary circulation was demonstrated. In most cases of chronic inflammatory pulmonary disease, the bronchial arteries were dilated and bronchopulmonary anastomoses were visualized. These changes seemed to be a measure of the extent of the disease and of the severity of the functional disturbance in pulmonary tissue, even when only regional. Selective bronchial arteriography is recommended in all cases of haemoptysis, in chronic pulmonary collapse and in chronic inflammatory lung disease in order to determine the source of the bleeding and the extent of involvement of the pulmonary interstitium.     

Case report 651

A thrombosed, leaking aneurysm of the popliteal artery, mimicking a soft tissue sarcoma both clinically and by MRI examination, is described. It may be difficult to separate a leaking, thrombosed aneurysm from an inflammatory response secondary to a sarcoma with intralesional hemorrhage. An aneurysm should, however, be considered in the differential diagnosis if the mass is present in a well-recognized location for aneurysm and is associated with vascular engulfment and signs of subacute or chronic hemorrhage.     

Distribution of F-18 fluorodeoxyglucose (F-18 FDG) in abdominal aortic aneurysm: high accumulation in macrophages seen on PET imaging and immunohistology

A 68-year-old man was hospitalized for unstable angina and underwent emergency coronary artery bypass surgery. During the operation, a pulsatile large abdominal aortic aneurysm (AAA) was discovered. To define the optimal treatment of the abdominal aneurysm, after bypass surgery, CT scans and positron emission tomography (PET) were performed, as we routinely do. PET imaging combined with immunohistologic examination showed a region of increased F-18 FDG uptake corresponding to an inflammatory infiltrate in the aortic wall in contrast to the thrombus in the aneurysm (devoid of inflammatory cells). The luminal area showed midlevel F-18 FDG uptake corresponding to circulating mediators.     

Endovascular treatment of a superior mesenteric artery aneurysm secondary to Behcet's disease with Onyx (ethylene vinyl alcohol copolymer)

Behcet’s disease is a complex multisystemic chronic inflammatory disease that is characterized by oral and genital aphtous ulcers and vasculitis. Aneurysms of major arteries are the most important cause of mortality in Behcet’s disease. Four patients with superior mesenteric artery (SMA) aneurysms related to Behcet’s disease have been reported in the literature. We report here the first successful endovascular treatment of a giant, wide-necked SMA aneurysm secondary to Behcet’s disease. We performed a balloon-assisted embolization technique using ethylene vinyl alcohol copolymer (Onyx, ev3, Irvine, CA, USA). There were no signs of recurrence during 2-year follow-up.     

Thoracic aortic disease: Spectrum of multidetector computed tomography imaging findings

The clinical presentation of diseases involving the thoracic aorta ranges from a large number of asymptomatic patients with clinically undetectable thoracic aortic aneurysm to patients with symptoms of severe chest pain as a result of acute aortic dissection. Thoracic aortic disease often remains undiagnosed until a life-threatening complication occurs or the disease is discovered serendipitously on imaging studies performed for other purposes. Multidetector row computed tomography (MDCT) imaging of the aorta is used to diagnose various acute and chronic conditions, including aortic aneurysms, aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, traumatic injury, rupture, inflammatory disorders, and congenital malformations. This review illustrates the wide range of MDCT imaging findings of thoracic aortic disease.     

Mycotic aneurysms of the aorta: radiologic features

Four patients with a total of six mycotic aneurysms of the aorta were examined with computed tomography (CT) after intravenous contrast material enhancement, and with abdominal or thoracic aortography. In the three patients with mycotic aneurysms involving the abdominal aorta, CT scans showed a vascular paraaortic structure without calcified walls adjacent to a nondilated aorta, and a large non-contrast-enhanced retroperitoneal mass representing inflammatory tissue and blood from a contained aortic rupture. A CT scan of one aneurysm of the thoracic aorta demonstrated an enhanced saccular mass originating from the aorta without paraspinal component. In three of four patients, the CT findings were corroborated by aortographic evidence of an eccentric aneurysmal sac in an atypical location for atheromatous disease. In four patients with clinical manifestations suggesting mycotic aneurysm of the aorta, a combination of CT and angiographic imaging provided accurate diagnostic information for planning adequate and early surgical treatment.     

Indium-111 imaging of an inflammatory abdominal aortic aneurysm.

Indium-111-labeled leukocyte scanning has been shown to be a highly sensitive and specific imaging modality in the detection of abscess formation. Leukocyte infiltration occurs in a variety of inflammatory states as well as some noninflammatory states, leading to false-positive results. We report a case of an inflammatory abdominal aortic aneurysm imaged by 111In. It is not clear whether the activity noted is due to the inflammatory nature of the aneurysm or to hemorrhage present within the wall of the aneurysm.     

Inflammatory abdominal aortic aneurysm: a cause of urinary obstruction and acute renal failure

Abdominal aortic aneurysms are rare causes of ureteric obstruction. We report three cases of inflammatory abdominal aortic aneurysm producing hydronephrosis. In two patients acute renal failure preceded this presentation. The diagnosis can be established by computed tomography when mural thrombus, wall calcification, and an enhancing periaortic soft-tissue mantle are present. It is important to recognize this disease preoperatively.     

Inflammatory aneurysm of the aorta. Value of x-ray computed tomography and ultrasonography in the diagnosis of a case and review of the literature

Until recently inflammatory aneurysm of the aorta was discovered only at the time of surgery and confirmed by the pathologist. New imaging modalities, such as ultrasound and CT-scan now enable the radiologist to diagnose this entity before surgery, thus leading to a better surgical planning and reducing the operative morbidity. The authors report a case of inflammatory aneurysm of the aorta and review the literature on this entity.     

The value of computed tomography and ultrasound in cases of inflammatory aneurysms of the abdominal aorta

In a retrospective study 344 CT examinations of patients with suspected aneurysms of the abdominal aorta were evaluated with respect to the inflammatory character of the aneurysm. In 207 cases surgical therapy was conducted. In 144 of those 207 cases preoperative ultrasound examination results were also available. Frequency of inflammatory aneurysms, as classified by CT, was 10.2% (35/344) and in the subgroup of surgically treated aneurysms, 14.0% (29/207). Sensitivity and specifity of CT to realise the inflammatory type of aneurysm was 86.2% and 97.2%. The respective figures for ultrasound examinations on the basis of 144 surgically treated aneurysms were 26.1% and 100%. We conclude that even in cases of sonographically unequivocal abdominal aneurysms CT should be performed because ultrasound is not sufficiently sensitive to realise an inflammatory character of the aneurysm, which can have great impact on surgical strategy. Correspondence to: E. Rinast     

Primary aortoenteric fistula: A case report and brief review of the literature

Aortoenteric fistula is a life-threatening emergency and is associated with high morbidity and mortality. Prompt surgical intervention before the aneurysm ruptures lowers the mortality rate to about 50%. Potential imaging mimics for aortoenteric fistula include retroperitoneal fibrosis, mycotic aortic aneurysm, and infectious aortitis. Secondary aortoenteric fistula has relative higher incidence compared to primary and is more common with open aortic repair versus endovascular stent graft repair. Ectopic gas in the aneurysm sac and extravasation of enteric contrast into the aneurysm sac is diagnostic for aortoenteric fistula. However, enteric contrast is not recommended for routine evaluation of aortoenteric because the aforementioned finding is extremely rare. More common imaging findings include bowel loop appearing adherent to aneurysm sac with associated inflammatory stranding and foci or ectopic gas within the aneurysm sac or interposed between the bowel and aneurysm sac. Here we present a case of 52-year-old male who presents with incidental primary aortoenteric fistula.     

Sensitivity and specificity of CT in the diagnosis of inflammatory abdominal aortic aneurysms

PURPOSE: The purpose of this study is to assess the diagnostic ability (sensitivity and specificity) of CT in the diagnosis of inflammatory abdominal aortic aneurysm (IAAA) and to quantitatively evaluate its features. METHOD: A retrospective survey of 355 consecutive patients with abdominal aortic aneurysm and iliac artery aneurysm who underwent CT examination and surgical repair yielded 18 patients with operatively confirmed IAAA. The sensitivity, specificity, and diagnostic accuracy of CT were evaluated in this review. Eighteen IAAAs were then analyzed in terms of distribution and degree of perianeurysmal fibrosis as well as time-dependent change of CT values of the aneurysmal wall on contrast-enhanced CT. Complications related to IAAA were also determined. RESULTS: Fifteen of the 18 cases of IAAA could be easily diagnosed on CT prior to surgical repair. Three false-negative and one false-positive case were found. This gives a sensitivity rate of 83.3% for this imaging technique, with specificity and accuracy rates of 99.7 and 93.7%, respectively. Thickening of the aortic wall was noticed mostly in the anterolateral wall of the aneurysm as compared with the posterior wall. The thickness of the perianeurysmal fibrosis correlated neither with the size of aneurysm nor with the inflammatory reaction such as erythrocyte sedimentation rate, C-reactive protein level, and white blood cell count. CT indicated the complications in 7 of 18 patients with IAAA. These included hydronephrosis, aortoenteric fistula, and infected iliac aneurysm. CONCLUSION: CT scan with contrast enhancement was a highly reliable imaging modality for the diagnosis of IAAA.     

Hepatic artery aneurysm presenting with hemobilia in a patient with Behçet's disease: treatment with percutaneous transcatheteral embolization

We herein report a case of hemobilia caused by a hepatic artery aneurysm. A 40-year-old male patient with a history of Beh?et's disease with a thrombus hanging out of the papilla of Vater had a large hepatic aneurysm in angiography. The hepatic artery feeding the aneurysm was embolized. Endovascular treatment can treat patients with hepatic artery aneurysms caused by Beh?et's disease.     

Endovascular repair of inflammatory abdominal aneurysm: a retrospective analysis of CT follow-up

Retrospective radiologic and clinical midterm follow-up is reported for 10 patients with inflammatory abdominal aortic aneurysm (IAAA) after endovascular aortic aneurysm repair (EVAR). At a mean follow-up of 33 months, regression of the thickness of the perianeurysmal fibrosis (PAF) and decrease of aneurysmal sac diameter was observed in nine patients. Four EVAR-associated complications were observed: periinterventional dissection of femoral artery (n = 1), blue toe syndrome (n = 1), and stent-graft disconnection (n = 2). EVAR is the less invasive method of aneurysm exclusion in patients with IAAA with a comparable evolution of the PAF as reported after open repair.     

The role of gadolinium-enhanced MR imaging in the preoperative evaluation of inflammatory abdominal aortic aneurysm

Inflammatory abdominal aortic aneurysm is an uncommon variant of abdominal aortic aneurysms. Thorough preoperative imaging of the extent of the aneurysm and inflammation and the associated complications are crucial in the management of this condition. We report a case of inflammatory abdominal aortic aneurysm where, after the initial contrast-enhanced CT, gadolinium-enhanced MR imaging was used to define the true extent of the inflammation and differentiate inflammation from mural thrombus at the iliac extension of the aneurysm. The imaging appearances are presented and the impact of MR imaging on further surgical management options including endovascular repair are discussed.