Patients may present with malaise or fever, but the most frequent complaint in aortitis is arm claudication or numbness, while lower limbs seem to be less frequently affected. This is caused by decreased pulse pressure in these territories [1]. When measured, blood pressure difference is frequently over 10 mm Hg. Arm arteritis may result in a reading of reduced blood pressure in the arms, while systemic blood pressure is high, due to renal artery stenosis [2]. Depending on which vessels are affected, patients may complain of vertigo, headaches, neck pain as a result of carotid artery involvement [3], syncope, convulsions as a result of hypertensive encephalopathy, strokes, visual abnormalities caused by central retinal hypoperfusion (if inflammation has spread to this territory), myalgia, low back pain or pain in the lower limbs [4]. Coronary artery involvement consists of ostial stenosis, resulting in angina, myocardial infarction or heart failure. Pulmonary hypertension is less common, but, when present, causes dyspnea, cough and hemoptysis. Occasionally, the first manifestation of the disease may be sudden death. If the disease occurs in the context of rheumatoid disease, arthralgia, weight loss or fever may dominate the clinical picture. Skin involvement may consist of pyoderma gangrenosum, erythema nodosum or Raynaud phenomenon. Abdominal complaints consist of pain or intestinal bleeding.

Arterial auscultation reveals bruit, while heart murmurs usually signify aortic valvular regurgitation, due to ascending aortic dilatation. The inflammatory process may also involve the descending aorta, leading to aneurysm formation [5], dissection or rupture [6].

Aortitis may occur alone or may be a part of several rheumatologic disorders, like rheumatoid arthritis [7], Behçet disease [8], systemic lupus erythematosus [9], ankylosing spondylitis, polychondritis [10] or Cogan syndrome [11] or its etiology may be infectious (Salmonella species, Staphylococcus aureus, Clostridium septicum, Bacteroides fragilis, Campylobacter jejuni, Mycobacterium tuberculosis, Treponema pallidum [12], therefore the patient may also present with symptoms related to these underlying diseases.

• Fever

  The patient complained of a high fever, abdominal pain, diarrhea, hematochezia and arthralgia. [ncbi.nlm.nih.gov]

  Clinical presentation The presentation is non-specific with fever, pain and weight loss. [radiopaedia.org]

  After five days, she developed neurobehavioral impairment with persistent fever and she was admitted in the intensive care unit. [omicsonline.org]

• Relapsing Polychondritis

  Relapsing polychondritis (RP) is a rare systemic inflammatory disease primarily affecting the ears, nose and tracheobronchial tree cartilage, but also the cardiovascular system. Cardiovascular complications are the second cause of mortality in RP. [ncbi.nlm.nih.gov]

  Active aortitis in relapsing polychondritis. J Clin Pathol 2001;54(11):890–892. Crossref, Medline, Google Scholar 29 Wilson GE, Hasleton PS, Manns JJ, Marks JS. Relapsing polychondritis: bone marrow and circular fibrous nodules in the aorta. [pubs.rsna.org]

  polychondritis-associated aortitis. ( 28965131 ) Elourimi G....Abad S. 2017 42 Contrast-enhanced magnetic resonance imaging to detect chronic aortic dissection complicated by acute aortitis. ( 28828099 ) Ouchi K....Yoshitake M. 2017 43 Successful Hybrid [malacards.org]

  Other autoimmune diseases associated with aortitis include rheumatoid arthritis, spondyloarthritis, systemic lupus erythematosus, sarcoidosis, Behçet disease, relapsing polychondritis, ANCA associated vasculitis and Cogan syndrome. [vasculitisfoundation.org]

• Intermittent Fever

  A 49-year-old woman sought medical attention because of intermittent fever that lasted 2 weeks. She presented no further symptoms or physical signs to suggest the aetiology. The epidemiological context was irrelevant. [ncbi.nlm.nih.gov]

• Hypertension

  Pulmonary hypertension is less common, but, when present, causes dyspnea, cough and hemoptysis. Occasionally, the first manifestation of the disease may be sudden death. [symptoma.com]

  Seizures are often attributed to hypertensive encephalopathy. [web.archive.org]

  The etiology is usually hypertension and/or atherosclerotic disease; reaching a certain diameter often results in acute aortic syndrome. [ncbi.nlm.nih.gov]

  Images in Clinical Medicine Masao Takagi, M.D., and Mikiro Kato, M.D. 1 Citing Article A 66-year-old man with hypertension presented with a 1-month history of fever and 4 days of hoarseness. He reported no chest pain, cough, or dyspnea. [nejm.org]

• Arm Claudication

  Patients may present with malaise or fever, but the most frequent complaint in aortitis is arm claudication or numbness, while lower limbs seem to be less frequently affected. This is caused by decreased pulse pressure in these territories. [symptoma.com]

  The extremities become cool, and pain develops with use (ie, arm or leg claudication). [web.archive.org]

• Heart Murmur

  Arterial auscultation reveals bruit, while heart murmurs usually signify aortic valvular regurgitation, due to ascending aortic dilatation. [symptoma.com]

• Systolic Murmur

  Examination on admission, blood pressure was 104/40mmHg, heart rate 96/min. and grade 3/6 systolic murmur and diastolic murmur was heared. Serologic test was negative for syphilis, tuber-culosis, antinuclear body or viral titer. [webview.isho.jp]

• Hepatojugular Reflux

  Rales, edema, liver congestion, elevated venous pressure, and hepatojugular reflux, if present, signify the complication of heart failure. [web.archive.org]

• Anger

  Angers, France. 6 Department of Internal Medicine, CHRU of Tours, Tours, France. 7 Department of Internal Medicine, University Hospital of Brest, Brest, France. 8 Department of Hematology, Hospital of Vannes, Vannes, France. 9 Department of Medicine [ncbi.nlm.nih.gov]

• Encephalopathy

  Depending on which vessels are affected, patients may complain of vertigo, headaches, neck pain as a result of carotid artery involvement, syncope, convulsions as a result of hypertensive encephalopathy, strokes, visual abnormalities caused by central [symptoma.com]

  Seizures are often attributed to hypertensive encephalopathy. [web.archive.org]

Blood workup in aortitis should address the suspected etiology of the disease. The erythrocyte sedimentation rate and C-reactive protein are usually high, but nonspecific. Potentially useful activity markers include anti-endothelial cell antibodies [13], matrix metalloproteinase 3 and 9 [14] and interleukin 6 [15]. Rheumatoid tests should include anti-neutrophil cytoplasmic antibodies, rheumatoid factor, and antinuclear antibodies.

Several imaging modalities [16], like arteriography, computed tomography angiography, magnetic resonance angiography and fluorodeoxyglucose positron emission tomography [17] have proven their ability to detect vascular abnormalities in aortitis. Vascular echography may also be used to monitor wall thickness. Echocardiography is used to monitor ascending aorta dilatation or an aneurysm causing aortic insufficiency [18], while abdominal ultrasound may detect abdominal aorta aneurysms. Duplex ultrasound may detect wall thickening or the "halo" sign, consisting of the presence of a hypoechoic halo around the vascular lumen [19].

A literature review addresses current insights in the pathogenesis, diagnosis, and treatment of non-aneurysmal infectious aortitis. [ncbi.nlm.nih.gov]

Mello Syphilitic aortitis: diagnosis and treatment. Case report Rev Bras Cir Cardiovasc, 25 (2010), pp. 415-418 [9] L.V. Stamm Syphilis: antibiotic treatment and resistance [10] B.P. [bjid.org.br]

Differential diagnosis, prognosis, and therapeutic strategies are discussed. [ncbi.nlm.nih.gov]

[…] depends on age, sex, occupation, stage of infection, site and extent of lesion, nature of lesion (progressive or stationary), response to treatment, cardiac efficiency, presence of complications The prognosis is better in patients with uncomplicated [pathologyoutlines.com]

Further studies into diagnostic criteria, disease prevalence, prognosis, therapeutic interventions, and differentiating possible localized hypersensitivity reactions from systemic disease are areas of active investigation. [journals.lww.com]

Pathology Etiology infectious syphilitic aortitis tuberculous aortitis pyogenic aortitis: especially Salmonella infection aortitis due to HIV infected (mycotic) aortic aneurysm non-infectious giant cell arteritis Takayasu arteritis other rheumatologic [radiopaedia.org]

The etiology is usually hypertension and/or atherosclerotic disease; reaching a certain diameter often results in acute aortic syndrome. [ncbi.nlm.nih.gov]

Blood workup in aortitis should address the suspected etiology of the disease. The erythrocyte sedimentation rate and C-reactive protein are usually high, but nonspecific. [symptoma.com]

The epidemiological context was irrelevant. Analyses revealed anaemia of chronic disease and significant elevations of inflammatory parameters. A comprehensive study was performed, which revealed presence of an aortitis. [ncbi.nlm.nih.gov]

The Changing Epidemiology of Syphilis. Sexually Transmitted Diseases. 2005, 32:S4-S10 [ivyunion.org]

In an epidemiological study [ 2 ] from Olmsted County, Minnesota, USA, the local county of the Mayo Clinic, the annual incidence of TA was found to be 17/100 000 person-years. [ejcts.oxfordjournals.org]

An extensive epidemiological study conducted in Japan in 1984 identified 20 cases per million population. [web.archive.org]

Mediterr J Rheumatol 2016;27(4):191-3 58-year-old patient with IgG4-related thoracic aortitis Authors Information Department of Pathophysiology, Medical School, University of Athens, Athens, Greece Abstract We report a 58-year-old male with a one-month [mjrheum.org]

Access personal reporting Related Content This Book Etiology, Pathogenesis and Pathophysiology of Aortic Aneurysms and Aneurysm Rupture Edited by Reinhart Grundmann Next chapter Drug-induced aortic aneurysms, ruptures and dissections By Olav Spigset Related [intechopen.com]

Definition / general Due to spirochete, Treponema pallidum Rare in developed and developing countries Male:female is 2:1 to 4:1 Affects aortic valve and ascending aorta Pathophysiology Treponema pallida reach cardiovascular system a short time after initial [pathologyoutlines.com]

J Rheumatol 2015 ; 42 : 1213 – 7. 9 Giant cell arteritis: a review of classification, pathophysiology, geoepidemiology and treatment. Autoimmun Rev 2012 ; 11 : A544 – 54. 10. [ejcts.oxfordjournals.org]

Aortitis Pathophysiology Anatomy and function The aorta is the largest artery in the human body. It arises from the left ventricle of the heart where it carries oxygen-rich blood recently received from the lungs. [healthhype.com]

Knowledge on underlying micro-organisms, antibiotic efficacy, risk factors, and prevention strategies has a key role in the management of this spectrum of infectious diseases involving the thoracic aorta. [ncbi.nlm.nih.gov]

For the prevention of an aortit timely therapy of primary diseases, prevention of STD, active detection of tuberculosis has paramount value. [medicine-for-you.com]

Management includes the following treatment priorities: stop the inflammation, treat complications, prevent and monitor for re-occurrence. If untreated, has three distinct phases. [en.wikipedia.org]

Early diagnosis and treatment is needed to prevent potentially life threatening complications. Disclosure statement: D.P.D’C.: Consultancies: AstraZenaca, Eli Lilly, GlaxoSmithKline, Roche. [academic.oup.com]

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