Aortic involvement in recent-onset giant cell (temporal) arteritis: a case-control prospective study using helical aortic computed tomodensitometric scan

OBJECTIVE: The prevalence of the involvement of large vessels in giant cell arteritis (GCA) is 3-13%. Aortitis is the most serious complication of GCA. Computed tomodensitometric (CT) scan allows analysis of both the aortic wall and endoluminal part of the aorta. Therefore, we conducted a study using CT scan to analyze aortic abnormalities in patients with recent-onset GCA. METHODS: This prospective controlled study compared patients with biopsy-proven GCA with a matched control group based on sex, age, and cardiovascular risk factors. During the 4-week period following diagnosis of GCA, patients underwent an aortic CT scan. The aortic imaging results were blindly compared between both groups. RESULTS: From January 5, 1998 to January 11, 1999, 22 patients and 22 controls were screened by CT scan for aortic involvement. Thickening of the aortic wall was more frequent among patients than controls (45.4% versus 13.6%; P = 0.02). Aortic thickening (mean 3.3 mm) was located on the ascending part of the thoracic aorta in 22.7% of the patients, with no evidence of thickening in the controls (P = 0.05). Thickening of the abdominal aortic wall was noted in 27.3% of the patients and none of the controls (P = 0.02). CONCLUSION: This study suggests that inflammatory aortic thickening, detected by CT scan, occurs frequently at the time of diagnosis of GCA, and that this condition predominantly occurs on the ascending part of the aorta.     

Temporal arteritis: a clinical approach

OBJECTIVE: To develop a clinical guide to the evaluation of temporal arteritis. DESIGN: A Medline English-language search of the literature from 1966 to 1998, including more than 300 articles about temporal arteritis, was performed to develop a guide to the evaluation of temporal arteritis. RESULTS: A user-friendly guide to the evaluation of temporal arteritis was developed based on the following criteria: (1) clinical suspicion, (2) laboratory testing, and (3) temporal artery biopsy. CONCLUSION: A clinical guide to the evaluation of temporal arteritis may assist clinicians in the care of patients with this condition.     

Multiple endovascular stent-graft implantations in a patient with aortic thoracic and abdominal aneurysms due Takayasu arteritis

We report an adult female patient with Takayasu arteritis (TA) receiving conventional medical treatment and anti-TNF therapy, which developed progressive thoracic and abdominal aortic aneurysms. She developed imminent rupture of the thoracic aneurysm and an endovascular stent-graft (EVSG) was emergency implanted and a year after this procedure the abdominal aneurysm increased in size requiring reoperation and placement of another EVSG. Both procedures had a very good outcome. This case shows the effectivity and security of multiple EVSG implantations in multiple aortic aneurisms in patients with TA.     

Clinical utility of routine screening for abdominal aortic aneurysm during echocardiography

BACKGROUND: The aim of this study was to determine the clinical utility of transthoracic echocardiography (TTE) as a screening method for the detection of abdominal aortic aneurysms (AAA). PATIENTS AND METHODS: Each patient who was referred to the echocardiography laboratory TTE was included into the study. After complete cardiac assessment the abdominal aorta was evaluated. Patients with a known, a clinically suspected, or a previously operated AAA were excluded. RESULTS: During the study period, 14,876 patients underwent TTE. 13,166 (88.5%) of the patients were 50 years and older. Of these 6953 (52.8%) were men and 6213 (47.2%) were women. A total of 108 (0.82%; 95% confidence interval (CI) 0.67-0.99) clinically unsuspected AAA of at least 3 cm in diameter (range 3 cm-6.8 cm) were detected. There were 93 (86.1%) men and 15 (13.9%) women with a mean age of 73.8 years (range 59-90). In 7 patients an AAA was suspected by TTE but not verified on subsequent abdominal ultrasound, as the diameter of the abdominal aorta was less than 3 cm. The prevalence of an AAA in patients 50 years and older was 1.34% (95% CI 1.08-1.64) for men and 0.24% (95% CI 0.14-0.40) for women. In patients less than 50 years old no aneurysm was detected. Seventeen patients who were found to have an AAA with a mean diameter of 4.4 cm (range 3-6 cm) underwent successful elective conventional AAA repair after a mean interval of 13.9 months (range 0.2-49 months) following the initial diagnosis. CONCLUSIONS: TTE performed in a highly selected cardiac patient group in a tertiary referral center is not a useful tool to screen for clinically unsuspected abdominal aortic aneurysms due to the low prevalence. The detection of an aneurysm should be confirmed by conventional abdominal ultrasound.     

The value of CT in diagnosing abdominal aortic aneurysm]

The CT scanning findings in 30 cases of the abdominal aortic aneurysm were analysed. The value of CT in diagnosing and following up of the abdominal aortic aneurysms was discussed. CT is recommended in comparison with other imaging technics. Thin slices and enhancement were made in order to show the relationship between aneurysm and the origin of the renal arteries when suspected.     

Repeated gallium-67 scan demonstrating an occult mycotic aneurysm of the aortic arch due to Salmonella

A 71 y-old female with 40 degrees C fever and a change in consciousness during haemodialysis was referred for a gallium-67 scan, which revealed a horseshoe-like radioactive accumulation in the mediastinal region. Salmonella enteritidis was isolated from blood culture. Magnetic resonance imaging confirmed an aortic arch aneurysm. The patient died without surgery.     

Temporal arteritis in Hong Kong

Objective: To evaluate Chinese patients with biopsy‐proven temporal arteritis in Hong Kong, focusing on clinical presentation, frequency of occurrence, treatment regimen and complications, management and outcome of these patients. Design: A retrospective study. Method: A retrospective study was undertaken in which patients with biopsy‐proven temporal arteritis were identified from: (i) Statistical records of Hospital Authority (1996–1999); (ii) pathology records of regional hospitals in Hong Kong (1996–2000); and (iii) case records from rheumatologists in two university hospitals. Indexed hospital and out‐patient records were reviewed and analysed. Results: Nineteen patients with biopsy‐proven temporal arteritis were identified from 1996 to 2000 and the calculated annual incidence was 0.34 patients in 100,000 people aged 50 and above per year. There were six male and 13 female patients (male : female ratio 1:2.2). Sixteen (84%) patients were older than 70 years. The common presentations were similar to overseas studies and included headache (79%), muscular symptoms (42%), constitutional symptoms (37%), scalp tenderness (37%), visual loss (32%), jaw claudication (32%), abnormal temporal artery (32%), and fever (26%). The mean erythrocyte sedimentation rate before treatment was 104 mm/h (SD = 30 mm/h). Anemia (Hb < 12 g/dL) was present in 79% of patients. The mean duration of symptoms before diagnosis was 8.4 weeks. Seventeen (89%) patients received high‐dose steroid therapy but none received steroid‐sparing agents. Only 33% of patients reached a physiological dose of steroid (prednisolone 5 mg/day) after 1 year. Conclusion: Temporal arteritis is rare among Hong Kong Chinese. A rough estimate of annual incidence yielded less than one per 100,000 people aged ≥ 50. Overall clinical presentation was similar to overseas studies but there were: (i) longer duration of steroid therapy given; and (ii) more complications from steroid use. Steroid‐sparing agents should be considered early in difficult‐to‐control cases.     

Usefulness of abdominal CT scan in severe peritoneal sepsis linked to primary peritonitis

We report 2 cases of primary group A streptococcal peritonitis in which emergency abdominal CT scan ruled out a hollow viscus perforation, or necrosis, avoiding unnecessary laparotomy. These cases highlight the usefulness of abdominal CT scan and suggest that blind surgical exploration has no advantages.     

Central nervous system involvement in pyothorax-associated lymphoma: ring enhancement on CT scan

A 71-year-old male was diagnosed as having pyothorax-associated lymphoma (PAL), a rare hematological malignancy associated with artificial pneumothorax for the treatment of pulmonary tuberculosis. Because of the low incidence, its clinical features have not been fully clarified. The PAL lesion in this patient disappeared after local radiotherapy and corticosteroid treatment. However, 8 months after the initial diagnosis, he developed a variety of neurological disorders and low-grade fever. Neither recurrence of the primary pulmonary lesion nor nodal enlargement was observed. Immediate magnetic resonance imaging of the brain revealed a ring-enhanced mass, suggesting a brain abscess. However, through a stereotactic biopsy of the brain lesion, infiltration of PAL cells was identified. The brain lesion rapidly enlarged despite intensive radiotherapy, and he finally died of lymphoma progression. This case demonstrates that PAL may progress as a type of extranodal lymphoma, and that brain lesions may produce a ring-enhanced pattern on computed tomography.     

Aortic involvement in recent‐onset giant cell (temporal) arteritis: A case–control prospective study using helical aortic computed tomodensitometric scan

Objective

The prevalence of the involvement of large vessels in giant cell arteritis (GCA) is 3–13%. Aortitis is the most serious complication of GCA. Computed tomodensitometric (CT) scan allows analysis of both the aortic wall and endoluminal part of the aorta. Therefore, we conducted a study using CT scan to analyze aortic abnormalities in patients with recent‐onset GCA.

Methods

This prospective controlled study compared patients with biopsy‐proven GCA with a matched control group based on sex, age, and cardiovascular risk factors. During the 4‐week period following diagnosis of GCA, patients underwent an aortic CT scan. The aortic imaging results were blindly compared between both groups.

Results

From January 5, 1998 to January 11, 1999, 22 patients and 22 controls were screened by CT scan for aortic involvement. Thickening of the aortic wall was more frequent among patients than controls (45.4% versus 13.6%; P = 0.02). Aortic thickening (mean 3.3 mm) was located on the ascending part of the thoracic aorta in 22.7% of the patients, with no evidence of thickening in the controls (P = 0.05). Thickening of the abdominal aortic wall was noted in 27.3% of the patients and none of the controls (P = 0.02).

Conclusion

This study suggests that inflammatory aortic thickening, detected by CT scan, occurs frequently at the time of diagnosis of GCA, and that this condition predominantly occurs on the ascending part of the aorta.     

Liver involvement in giant cell arteritis

Summary Giant cell arteritis is a vasculitis which usually affects large and medium-sized vessels in patients over 50 years old. The liver is one of the internal organs which can be involved in this systemic disease. During the last 15 years, 56 patients with giant cell arteritis were seen in our hospital. In 12 patients disturbed liver function tests were found. In the majority of cases the disturbance was of cholestatic type and resolved completely with steroid treatment. The association of temporal arteritis with disturbed liver function tests is discussed, with a review of the recent literature.