Infectious and noninfectious aortitis: cross-sectional imaging findings

"Aortitis" is a pathologic term that refers to an abnormal inflammation of the aortic wall. A wide spectrum of infectious, inflammatory, and idiopathic conditions may result in the development of aortitis. Infectious aortitis may be secondary to bacterial, tubercular, syphilitic, and viral pathogens. Although Takayasu arteritis and giant cell arteritis are the most common rheumatologic causes of aortitis, the other systemic diseases, such as rheumatoid arthritis, systemic lupus erythematosus, Behçet disease, and Cogan syndrome, may also be associated with aortitis. In addition, aortitis may also occur without any systemic diseases or infectious causes (idiopathic). Clinical features of aortitis are nonspecific and may include fever, abdominal or chest pain, and vascular insufficiency. Patients may have elevated serum levels of acute phase reactants. A high index of clinical suspicion is always needed for the diagnosis of aortitis in a timely manner. Cross-sectional imaging techniques, such as computed tomographic angiography, magnetic resonance imaging, magnetic resonance angiography, and positron emission tomography, are extremely helpful in diagnosis, assessing disease activity, treatment planning, and post-treatment follow-up. Many of the patients with aortitis may require a multimodality imaging approach for appropriate diagnosis. Knowledge of the clinical features and cross-sectional imaging findings of different types of aortitis permit optimal patient management.