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Inflammatory ascending aortic disease: perspectives from pathology

Joseph J Maleszewski1

  • 1Division of Anatomic Pathology, Mayo Clinic, Rochester, Minn.

The Journal of Thoracic and Cardiovascular Surgery
|September 10, 2014
PubMed

Insights

Inflammatory aortic diseases range from rare infections to common atherosclerosis. This review details various inflammatory aortopathies affecting the ascending aorta, aiding clinical and pathological distinctions.

Area of Science:

  • Cardiovascular Pathology
  • Immunology
  • Vascular Medicine

Background:

  • Inflammatory aortic diseases present diverse clinical and histopathologic features.
  • Diseases are broadly categorized into infectious and noninfectious types.
  • Infectious aortitis is uncommon, caused by bacteria, fungi, or mycobacteria.

Purpose of the Study:

  • To review inflammatory diseases of the aorta, focusing on the ascending aorta.
  • To highlight the defining characteristics of various inflammatory aortopathies.
  • To discuss key clinical and pathological distinctions between these conditions.

Main Methods:

  • Literature review of infectious and noninfectious inflammatory aortic diseases.
  • Analysis of histopathologic and clinical presentations.
  • Focus on ascending aorta involvement and differential diagnoses.

Main Results:

  • Noninfectious forms include atherosclerosis, giant cell arteritis, Takayasu arteritis, granulomatosis with polyangiitis, sarcoidosis, and lymphoplasmacytic aortitis.
  • Atherosclerosis primarily affects the intima but impacts media and adventitia, potentially causing aneurysms.
  • Lymphoplasmacytic aortitis may be associated with IgG4-related sclerosing disease, impacting treatment.

Conclusions:

  • Understanding the spectrum of inflammatory aortopathies is crucial for accurate diagnosis.
  • Distinguishing between infectious and noninfectious causes, and specific noninfectious types, is clinically significant.
  • Recognition of IgG4-related sclerosing disease in aortitis has therapeutic implications.

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