Inflammatory aortic aneurysm

AneurysmAorta

Inflammatory Aortic Aneurysm is a specific subtype of aortic aneurysm characterized by the presence of a marked inflammatory response in the aortic wall. Unlike the more common atherosclerotic aneurysms, inflammatory aortic aneurysms involve a dense fibrotic thickening of the aorta's adventitia (the outermost layer of the aortic wall) and often present with systemic signs of inflammation.

Etiology and Pathogenesis

The exact cause of inflammatory aortic aneurysms remains unclear, but they are thought to represent an aberrant immune response. The inflammation may be triggered by atherosclerotic changes within the aorta, but the extent of inflammation goes beyond the typical atherosclerotic process. The inflammatory infiltrate is primarily composed of lymphocytes and plasma cells, with fibrosis surrounding the aorta and sometimes involving adjacent structures such as the ureters, leading to complications such as hydronephrosis.

Clinical Presentation

Patients with an inflammatory aortic aneurysm may present with a variety of symptoms, including abdominal or back pain, weight loss, and symptoms of systemic inflammation such as fever and elevated inflammatory markers (e.g., C-reactive protein and erythrocyte sedimentation rate). The presence of an abdominal mass may also be noted on physical examination.

Diagnosis

Diagnosis of an inflammatory aortic aneurysm is typically made through imaging studies. Computed tomography (CT) angiography is the preferred modality, as it can clearly delineate the size of the aneurysm, the extent of the inflammatory process, and its effect on adjacent structures. Magnetic resonance imaging (MRI) may also be useful, particularly in patients for whom CT contrast agents are contraindicated.

Treatment

The treatment of inflammatory aortic aneurysms involves managing the aneurysm itself as well as the inflammatory component. Surgical repair, either through open surgery or endovascular aneurysm repair (EVAR), is the definitive treatment for the aneurysm. Preoperative or postoperative administration of corticosteroids may be considered to reduce inflammation, although the evidence supporting this approach is limited. Close monitoring of the patient's inflammatory markers and imaging studies is essential to assess treatment response and detect complications.

Prognosis

The prognosis for patients with inflammatory aortic aneurysms is generally favorable with appropriate treatment. However, the condition can lead to significant morbidity if not promptly diagnosed and managed, due to the risk of aneurysm rupture and the potential for involvement of adjacent organs.

See Also

• Aortic aneurysm
• Atherosclerosis
• Computed Tomography Angiography
• Magnetic Resonance Imaging