Isolated periaortitis is a non-aneurysmal form of chronic periaortitis.
- weight loss
- mesenteric arterial ischaemia: abdominal pain, diarrhoea, and gastrointestinal hemorrhage
- renal artery stenosis: renovascular hypertension
- vascular impairment depending on which other vessels are involved
Periaortitis may be a local immune response to antigens like oxidised low density lipoproteins and ceroid found in the atherosclerotic plaques of the abdominal aorta. The disease tends primarily to involve the vascular structures causing stenosis of the major branches of the abdominal aorta (e.g. coeliac trunk, superior mesenteric artery, renal arteries).
- low-density periaortic enhancing mantle of soft tissue
- abdominal aorta and its major branches appear to be narrowed.
Signal characteristics of affected regions include:
- T1: hypointense
- T2: hyperintense
- C+ (Gd): intense enhancement
PET scan with 18F-fluorodeoxyglucose is an excellent tool in assessing the metabolic activity of the mass, detecting other sites of inflammation and disclosing infectious or neoplastic lesions with which periaortitis may be associated.
Treatment and prognosis
Steroids are usually effective and induce remission of the clinical symptoms, normalization of the acute-phase reaction, reduction in size of the retroperitoneal mass and also resolution of the obstructive complications. A number of immunosuppressive drugs, such as azathioprine, cyclophosphamide, and methotrexate, have been used as steroid-sparing agents or in patients not responding to steroids alone or when steroids cannot be tapered.
- 1. Zeina AR, Slobodin G, Gleb S et-al. Isolated periaortitis: clinical and imaging characteristics. Vasc Health Risk Manag. 2008;3 (6): 1083-6. Free text at pubmed - Pubmed citation
- 2. Vaglio A, Buzio C. Chronic periaortitis: a spectrum of diseases. Curr Opin Rheumatol. 2005;17 (1): 34-40. Pubmed citation
- 3. Salvarani C, Pipitone N, Versari A et-al. Positron emission tomography (PET): evaluation of chronic periaortitis. Arthritis Rheum. 2005;53 (2): 298-303. doi:10.1002/art.21074 - Pubmed citation
- acute aortic syndrome
- thoracic aortic aneurysm
- abdominal aortic aneurysm
- endovascular aneurysm repair (EVAR)
- reporting tips for aortic aneurysms
- aortic coarctation
- aortic pseudocoarctation
- cervical aortic arch
- interrupted aortic arch
- transposition of the great arteries
- variant anatomy of the aortic arch
- traumatic aortic injury