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Acute dissecting thoracic aortic aneurysm in a patient with polymyalgia rheumatica

Tomohiro Koga1, Taichiro Miyashita, Yojiro Matsuoka

  • 1Department of General Internal Medicine, NHO National Nagasaki Medical Center, Nagasaki, Japan.

The American Journal of the Medical Sciences
|November 16, 2007
PubMed

Insights

Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) can increase aortic dissection risk. Early recognition and treatment are crucial, even after initial symptoms resolve.

Area of Science:

  • Rheumatology
  • Cardiovascular Medicine
  • Pathology

Background:

  • Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are common inflammatory conditions in older adults.
  • Vasculitis is implicated in the pathogenesis of PMR.
  • Both conditions require long-term management, often involving corticosteroids.

Observation:

  • A patient with PMR and aortitis, initially responsive to steroid therapy, developed chest pain.
  • The patient was diagnosed with a dissecting aortic aneurysm.
  • Aortitis in the resected aorta showed mononuclear cell infiltration, including giant cells, around the vaso vasorum, disrupting the elastic lamina.

Findings:

  • The case highlights a potential link between PMR/GCA and aortic dissection.
  • Histological findings confirm vasculitic changes in the aorta.
  • Aortic dissection can occur even with normal inflammatory markers (ESR, CRP) and after initial disease control.

Implications:

  • PMR and GCA may signify an elevated risk for aortic dissection.
  • Vigilant monitoring for aortic complications is essential in patients with PMR/GCA.
  • Timely diagnosis and intervention for aortic dissection are critical, irrespective of active inflammatory symptoms.

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