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(Circulation. 2008;118:1214-1216.)
© 2008 American Heart Association, Inc.

Images in Cardiovascular Medicine

Chronic Periaortitis

Nicolò Pipitone, MD, PhD; Alessandra Ghinoi, MD; Annibale Versari, MD; Augusto Vaglio, MD; Alessandra Palmisano, MD; Carlo Salvarani, MD

From the Departments of Rheumatology (N.P., A.G., C.S.) and Nuclear Medicine (A. Versari), Arcispedale Santa Maria Nuova, Reggio Emilia, Italy, and Department of Clinical Medicine, Nephrology, and Health Science (A. Vaglio, A.P.), University of Parma, Parma, Italy.

Correspondence to Dr Carlo Salvarani, Department of Rheumatology, Arcispedale Santa Maria Nuova, Viale Risorgimento, 80, 42100 Reggio Emilia, Italy. E-mail Salvarani.carlo@asmn.re.it

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 60-year-old woman presented in 2004 with fatigue, anorexia, and weight loss. Her erythrocyte sedimentation rate and C-reactive protein levels were elevated at 114 mm/h and 45 g/dL (normal values <6 g/dL), respectively, whereas autoimmune serology, including antinuclear antibodies, antibodies to extractable nuclear antigens, and antineutrophil cytoplasmic antibodies, and tests for common infectious diseases, including tuberculosis, were normal or negative. Occult neoplasm was suspected and computerized tomography (CT) of the abdomen and F18-fluorodeoxyglucose positron emission tomography (PET) were scheduled. CT showed concentric wall thickening of the aortic arch, ascending thoracic aorta, and proximal left internal carotid arteries, with a perivascular cuff around the abdominal aorta. PET disclosed increased tracer uptake at the ascending and abdominal aorta and, to a lesser extent, in the common iliac arteries. Chronic periaortitis (CP) was diagnosed on the basis of these symptoms and findings, and treatment with prednisone 1 mg · kg^–1 · d^–1 was begun, with marked clinical improvement and normalization of erythrocyte sedimentation rate and C-reactive protein level. A repeat CT scan demonstrated a reduction in the size of the abdominal periaortic cuff, and a second PET scan documented reduced tracer uptake in the ascending and abdominal aortas with unchanged iliac artery uptake. However, attempts to taper the glucocorticoid dose resulted in 3 flares over the subsequent 3 years that required retreatment with high-dose glucocorticoids in combination with methotrexate. At her last visit in 2007, the patient complained of fatigue. Her erythrocyte sedimentation rate was 72 mm/h and her C-reactive protein level was . . . [Full Text of this Article]