[Inflammatory aneurysms of the abdominal aorta]

Area of Science:

• Vascular Surgery
• Radiology
• Pathology

Background:

• Inflammatory abdominal aortic aneurysm (IAAA) is a distinct subtype of arteriosclerotic aneurysm, occurring in 5-15% of cases.
• Pathologically, IAAs exhibit periaortic fibrotization with lymphocytous and plasmacellular infiltrates in the adventitia.
• The etiology of IAAs remains unclear, complicating surgical approaches due to adhesions with adjacent structures.

Purpose of the Study:

• To highlight the diagnostic features of inflammatory abdominal aortic aneurysms.
• To emphasize the importance of preoperative diagnosis for surgical planning.
• To differentiate IAAs from other retroperitoneal pathologies.

Main Methods:

• Review of pathological and imaging findings in IAAs.
• Sonographic evaluation of aneurysm structure, including characteristic fourfold stratification.
• Differential diagnosis considerations for IAAs.

Main Results:

• Sonography can confirm suspected abdominal aortic aneurysms, revealing a specific fourfold stratification in partially thrombotic cases: free lumen, thrombus, calcified aortic wall, and a low-echo outer inflammatory layer.
• The inflammatory component appears as a tapelike, semicircular, and variably developed layer.
• IAAs are often symptomatic, necessitating differentiation from conditions like covered perforation, dissecting aortic aneurysm, Ormond's disease, lymphomas, and other retroperitoneal tumors.

Conclusions:

• Preoperative diagnosis of IAAs is crucial due to surgical complexities.
• Sonography is a valuable tool for identifying the characteristic features of IAAs.
• Accurate diagnosis aids in surgical planning and differentiation from other serious abdominal conditions.