Circulation. 2007;116:e508-e511
doi: 10.1161/CIRCULATIONAHA.107.730671
(Circulation. 2007;116:e508-e511.)
© 2007 American Heart Association, Inc.
Images in Cardiovascular Medicine |
Inflammatory Aneurysm of the Ascending Aorta
Dissection Ante Portas?
Matthew Panagiotou, MD, FETCS;
Konstantinos Markakis, MD;
Alexia Tsigka, MD, MSc;
Loukianos S. Rallidis, MD, FESC;
Dimitrios T. Kremastinos, MD, FESC
From the Cardiac Surgery Department (M.P., K.M., A.T.), Athens Medical Center, and Second Department of Cardiology (L.S.R., D.T.K.), University General Hospital, "Attikon," Athens, Greece.
Correspondence to Loukianos Rallidis, 74 Thermopylon St, Argyroupolis 16451, Athens, Greece. E-mail rallidis{at}ath.forthnet.gr
A 72-year-old woman with a medical history of hypertension and non–insulin-dependent diabetes mellitus was admitted to our hospital with progressively deteriorating chest pain. Coronary angiography demonstrated significant disease in the left anterior descending and proximal circumflex arteries. Contrast-enhanced computed tomography of the thoracic aorta revealed an ascending aorta aneurysm with a maximal diameter of 5.3 cm and a thick wall (Figure 1). At surgery, the ascending aorta appeared white, glistening, and edematous (peau d’ orange) with circumferential thickening, suggesting an inflammatory process (Figure 2). The patient underwent an ascending aorta and hemiarch replacement with a tubular graft combined with double CABG. During surgical manipulation, we verified a remarkable tendency of the aortic wall toward dissection. The procedure was well tolerated, and recovery was uneventful. Histological examination of the resected specimen revealed a markedly thickened tunica adventitia and an edematous tunica media with signs of dissection between these 2 layers (Figure 3). In addition, there was infiltration with lymphocytes and plasma cells (Figure 4).
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Figure 2. Intraoperative view of anterior wall of aneurysm of ascending aorta. The wall appears polished white, glistening, and edematous (peau d’ orange) with circumferential thickening.
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Figure 3. Microscopic indication of rupture (yellow arrow) between tunica adventitia and tunica media (hematoxylin and eosin, original magnification x20).
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Figure 4. Inflammatory infiltration with lymphocytes and numerous plasma cells (hematoxylin and eosin, original magnification x400).
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Inflammatory aneurysms of ascending aorta are extremely rare, and the diagnosis is very difficult preoperatively.1–3 In our patient, the macroscopic and microscopic findings were highly suggestive of an impending "catastrophic" aortic dissection. This raises the question of whether this fragile inflammatory condition requires surgery at earlier stages than other aneurysms of the ascending aorta.
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Disclosures
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None.
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References
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1. Kunzli A, von Segesser LK, Vogt PR, Spahn DR, Schneider J, Jenni R, Turina MI. Inflammatory aneurysm of the ascending aorta.
Ann Thor Surg. 1998; 65: 1132–1133.
[Abstract/Free Full Text]2. Gasparovic H, Nascimben L, Kindelberger DW, Byrne JG. Idiopathic inflammatory aneurysm of the ascending aorta. Ann Thor Surg. 2005; 80: 1912–1914.[Abstract/Free Full Text]
3. Dhareshwar J, Estrera AL, Covinsky MH, Safi HJ. Inflammatory aneurysm of the ascending aorta. Eur J Cardiothorac Surg. 2006; 30: 806–807.[Abstract/Free Full Text]
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Disclosures
References