Chronic Periaortitis – Review and Presentations

Main Article Content

Savita Taribagil
Sabrina Bhattacharya
Priyal Taribagil
Vadivelu Saravanan
Vish Bhattacharya

Abstract

Chronic periaortitis is a rare inflammatory condition predominantly affecting the abdominal segment of the aorta. This can present as IgG4 related inflammatory disease, idiopathic retroperitoneal fibrosis, perianeurysmal retroperitoneal fibrosis and inflammatory abdominal aortic aneurysm (IAAA). Aortitis can also be a manifestation of a number of rheumatological large vessel vasculitides such as Takayasu arteritis and giant cell arteritis (GCA). We present three interesting cases of chronic periaortitis and a literature review. The first case shows a classic picture of IgG4 periaortitis. The second case illustrates periaortitis with retroperitoneal fibrosis, ureteric involvement and hydronephrosis, following abdominal aortic aneurysmal stenting. The final case presents as widespread periaortitis due to Takayasu's disease involving the entire aorta including the arch and root of the subclavian artery.

Keywords:
Periaortitis, IgG4 related disease, retroperitoneal fibrosis, Takayasu's disease, FDG- PET scan, CT scan, corticosteroids

Article Details

How to Cite
Taribagil, S., Bhattacharya, S., Taribagil, P., Saravanan, V., & Bhattacharya, V. (2020). Chronic Periaortitis – Review and Presentations. Journal of Advances in Medicine and Medical Research, 32(11), 15-25. https://doi.org/10.9734/jammr/2020/v32i1130527
Section
Case Study

References

Shogo Doi, Yasuyoshi Kuroiwa, Kazunori Kusumoto, Atsushi Yamashita, Eiji Furukoji, et al Therapeutic response of immunoglobulin 4-related aortitis and pancreatitis demonstrated by diffusion weighted MRI Radiol Case Rep. 2019; 14(9):1132–1135.

Ozawa M, Fujinaga Y, Asano J, Nakamura A, Watanabe T, Ito T, et al. Clinical features of IgG4- related periaortitis/periarteritis based on the analysis of 179 patients with IgG4-related disease: a case-control study. Arthritis Res Ther [Internet]. 2017-2020;31; 19(1):223.

Available:http://www.ncbi.nlm.nih.gov/pubmed/28978347

Hamano H, Kawa S, Ochi Y, Unno H, Shiba N, Wajiki M, et al. Hydronephrosis associated with retroperitoneal fibrosis and sclerosing pancreatitis. Lancet (London, England) [Internet]. 2002-2020;359(9315): 1403–4.

Available:http://www.ncbi.nlm.nih.gov/pubmed/11978339

Kobayashi H, Shimokawaji T, Kanoh S, Motoyoshi K, Aida S. IgG4-positive pulmonary disease. J Thorac Imaging [Internet]. 2007-2020;22(4):360–2.

Available:http://www.ncbi.nlm.nih.gov/pubmed/18043395

Yoshimura Y, Takeda S, Ieki Y, Takazakura E, Koizumi H, Takagawa K. IgG4-associated prostatitis complicating autoimmune pancreatitis. Intern Med [Internet]. 2006-2020;45(15):897–901.

Available:http://www.ncbi.nlm.nih.gov/pubmed/16946571

Mavrogeni S, Markousis-Mavrogenis G, Kolovou G. IgG4-related cardiovascular disease. The emerging role of cardiovascular imaging. Eur J Radiol [Internet]. 2017-2020;86:169–75.

Available:http://www.ncbi.nlm.nih.gov/pubmed/28027743

Chen LYC, Mattman A, Seidman MA, Carruthers MN. IgG4-related disease: what a hematologist needs to know. Haematologica [Internet]. 2019-2020; 104(3):444–55.

Available:http://www.ncbi.nlm.nih.gov/pubmed/30705099

Weindorf SC, Frederiksen JK. IgG4-Related Disease: A Reminder for Practicing Pathologists. Arch Pathol Lab Med [Internet]. 2017-2020;141(11):1476–83.

Available:http://www.ncbi.nlm.nih.gov/pubmed/29072949

Kasashima S, Zen Y, Kawashima A, Konishi K, Sasaki H, Endo M, et al. Inflammatory abdominal aortic aneurysm: close relationship to IgG4-related periaortitis. Am J Surg Pathol [Internet]. 2008-2020;32(2):197–204.

Available:http://www.ncbi.nlm.nih.gov/pubmed/18223321

Sakata N, Tashiro T, Uesugi N, Kawara T, Furuya K, Hirata Y, et al. IgG4-positive plasma cells in inflammatory abdominal aortic aneurysm: the possibility of an aortic manifestation of IgG4-related sclerosing disease. Am J Surg Pathol [Internet]. 2008-2020;32(4):553–9.

Available:http://www.ncbi.nlm.nih.gov/pubmed/18300798

Matsumoto Y, Kasashima S, Kawashima A, Sasaki H, Endo M, Kawakami K. A case of multiple immunoglobulin G4-related periarteritis: a tumorous lesion of the coronary artery and abdominal aortic aneurysm. Hum Pathol [Internet]. 2008-2020;39(6):975–80.

Available:http://www.ncbi.nlm.nih.gov/pubmed/18430457

Ito H, Kaizaki Y, Noda Y, Fujii S, Yamamoto S. IgG4-related inflammatory abdominal aortic aneurysm associated with autoimmune pancreatitis. Pathol Int [Internet]. 2008-2020;58(7):421–6.

Available:http://www.ncbi.nlm.nih.gov/pubmed/18577110

Augusto Vaglio, Federica Maritati J. Am Soc Nephrol. Idiopathic Retroperitoneal Fibrosis 2016; 27(7):1880–1889.

DOI: 10.1681/ASN.2015101110

Zen Y, Onodera M, Inoue D, Kitao A, Matsui O, Nohara T, et al. Retroperitoneal Fibrosis: A Clinico-pathologic Study With Respect to Immunoglobulin G4. Am J Surg Pathol [Internet]. 2009-2020;33(12):1833–9.

Available:http://journals.lww.com/00000478-200912000-00013

Mizushima I, Inoue D, Yamamoto M, Yamada K, Saeki T, Ubara Y, et al. Clinical course after corticosteroid therapy in IgG4-related aortitis/periaortitis and periarteritis: a retrospective multicenter study. Arthritis Res Ther [Internet]. 2014-2020;16(4): R156.

Available:http://www.ncbi.nlm.nih.gov/pubmed/25056443

Castelein T, Coudyzer W, Blockmans D. IgG4-related periaortitis vs idiopathic periaortitis: Is there a role for atherosclerotic plaque in the pathogenesis of IgG4-related periaortitis? Rheumatology (Oxford) [Internet]. 2015-2020;54(7):1250–6.

Available:http://www.ncbi.nlm.nih.gov/pubmed/25587179

Meier P, Vogt B, Blanc E. Rethinking the Triggering Inflammatory Processes of Chronic Periaortitis. Nephron Exp Nephrol [Internet]. 2006-2020;105(1):17–23.

Available:http://www.ncbi.nlm.nih.gov/pubmed/17108706

Mizushima I, Kasashima S, Fujinaga Y, Kawano M, Ishizaka N. IgG4-related periaortitis/periarteritis: An under-recognized condition that is potentially life-threatening. Mod Rheumatol [Internet]. 2019-2020;29(2): 240–50.

Available:https://www.tandfonline.com/doi/full/10.1080/14397595.2018.1546367

Peng L, Zhang P, Li J, Liu Z, Lu H, Zhu L, et al. IgG4-related aortitis/periaortitis and periarteritis: A distinct spectrum of IgG4-related disease. Arthritis Res Ther [Internet]. 2020-2020;22(1):103.

Available:http://www.ncbi.nlm.nih.gov/pubmed/32366271

Cha MJ, Chong S, Kim YS, Park B, Seo JH, Lee ES. Immunoglobulin G4-Related Periaortitis Involving the Aortic Arch Mimicking a Mediastinal Tumor; 2017-2020.

Available:http://dx.doi.org/10.1016/j.athoracsur.2016.08.109

Palmisano A, Vaglio A. Chronic periaortitis: a fibro-inflammatory disorder. Best Pract Res Clin Rheumatol [Internet]. 2009-2020; 23(3):339–53.

Available:https://www.sciencedirect.com/science/article/pii/S1521694208001526

Inoue D, Zen Y, Abo H, Gabata T, Demachi H, Yoshikawa J, et al. Immunoglobulin G4–related Periaortitis and Periarteritis: CT Findings in 17 Patients. Radiology [Internet]. 2011-2020; 261(2):625–33.

Available:http://pubs.rsna.org/doi/10.1148/radiol.11102250

Inoue D, Zen Y, Abo H, Gabata T, Demachi H, Yoshikawa J, et al. Immunoglobulin G4-related periaortitis and periarteritis: CT findings in 17 patients. Radiology [Internet]. 2011-2020;261(2): 625–33.

Available:http://www.ncbi.nlm.nih.gov/pubmed/21803920

Abe A, Takano K, Seki N, Jitsukawa S, Yamamoto M, Takahashi H, et al. The clinical characteristics of patients with IgG4-related disease with infiltration of the labial salivary gland by IgG4-positive cells. Mod Rheumatol [Internet]. 2014-2020; 24(6):949–52.

Available:http://www.tandfonline.com/doi/full/10.3109/14397595.2014.891964

Huang X, Lu B, Li M, Fan Y, Zhang L. IgG4-related retroperitoneal fibrosis overlapping with primary biliary cirrhosis and primary Sjögren’s syndrome: A case report. Medicine (Baltimore) [Internet]. 2018-2020;97(26).

Available:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6039603/

Mizushima I, Inoue D, Yamamoto M, Yamada K, Saeki T, Ubara Y, et al. Clinical course after corticosteroid therapy in IgG4-related aortitis/periaortitis and periarteritis: a retrospective multicenter study [Internet]; 2014-2020.

Available:http://arthritis- research.com/content/16/4/R156

Perugino CA, Wallace ZS, Meyersohn N, Oliveira G, Stone JR, Stone JH. Large vessel involvement by IgG4-related disease. Medicine (Baltimore) [Internet]. 2016-2020;95(28):3344. Available:http://www.ncbi.nlm.nih.gov/pubmed/27428181

Jois RN, Gaffney K, Marshall T, Scott DGI. Chronic periaortitis. Rheumatology [Internet]. 2004-2020; 43(11):1441–6.

Available:https://academic.oup.com/rheumatology/article lookup/doi/10.1093/rheumatology/keh326

T T, JR B, AK D, K V. Inflammatory Abdominal Aortic Aneurysms. Eur J Vasc Endovasc Surg [Internet]. 2005-2020;29(4).

Available:https://pubmed.ncbi.nlm.nih.gov/15749035/

Bonati L, Rubini P, Japichino GG, Parolari A, Contini S, Zinicola R, et al. Long-term outcome after inflammatory abdominal aortic aneurysm repair: case-matched study. World J Surg [Internet]. 2003-2020;27(5):539–44.

Available:http://www.ncbi.nlm.nih.gov/pubmed/12715219

Sakai K, Watanabe T, Yoshida T. Endovascular treatment of immunoglobulin G4-related inflammatory abdominal aortic aneurysm. J Vasc Surg Cases Innov Tech [Internet]. 2018-2020 ;4(3): 189.

Available:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6105760/