Nonaneurysmal Aortoarteritis

Abstract

Aortoarteritis is an uncommon form of retroperitoneal inflammation, which is not associated with an aortic aneurysm or luminal stenosis. The authors report 3 patients with periaortic inflammation whose presentations were initially suggestive of a symptomatic aortic aneurysm. All 3 patients had pain, an epigastric mass, and weight loss. The correct diagnosis was suggested by imaging techniques and confirmed by computerized (CT) -directed needle biopsy in 2 of the patients. Aortic caliber was not altered significantly in any patient. They were all treated with corticosteroids with prompt relief of symptoms and rapid resolution of the periaortic inflammation as confirmed by CT. There has been no recurrence of symptoms in follow-up. Aortoarteritis appears to be one expression of the spectrum of inflammatory retroperitoneal diseases and is distinct from inflammatory aortic aneurysms and retroperitoneal fibrosis. The authors suggest a logical classification scheme of retroperitoneal inflammation based on the extent of aortic and retroperitoneal involvement. Differentiation between these entities is critical because, in contrast to inflammatory aneurysms and retroperitoneal fibrosis involving the aorta, aortoarteritis can be managed without surgery. Magnetic resonance imaging displays the most detail of the periaortic mass and provides information about intra-aortic flow. Corticosteroids are rapidly effective and are the treatment of choice in aortoarteritis when the diagnosis is established.