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An Immunohistopathologic Study to Profile the Folate Receptor Beta Macrophage and Vascular Immune Microenvironment in Giant Cell Arteritis
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Giant cell aortitis masquerading as intramural hematoma.

Melanie F McCormick1, Jing Li1, Luke Monteagudo2

  • 1Division of Vascular Surgery, Department of Surgery, University of Minnesota Medical Center, Minneapolis, Minn.

Journal of Vascular Surgery Cases and Innovative Techniques
|December 9, 2020
PubMed
Summary

Giant cell aortitis, a rare cause of acute aortic syndrome, can present with chest pain and intramural hematoma. Early steroid treatment improved symptoms and imaging in two patients, highlighting its importance.

Keywords:
Giant cell arteritisIntramural hematomaNoninfectious fever

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Area of Science:

  • Cardiology
  • Vascular Surgery
  • Rheumatology

Background:

  • Giant cell aortitis is an uncommon cause of acute aortic syndrome.
  • It can mimic other aortic pathologies, complicating diagnosis.

Observation:

  • Two patients presented with chest pain, hypertension, and CT angiographic findings of thoracic aortic intramural hematoma.
  • Despite initial improvement with hypertension control, persistent fever and elevated inflammatory markers suggested an inflammatory cause.

Findings:

  • Empiric corticosteroid therapy led to rapid resolution of fever and normalization of inflammatory markers.
  • Temporal artery biopsies were positive for giant cell aortitis in both cases.
  • Follow-up imaging demonstrated significant improvement in aortic wall thickening after two weeks of steroid treatment.

Implications:

  • Giant cell aortitis should be considered in the differential diagnosis of acute aortic syndrome, especially with concurrent inflammatory markers and fever.
  • Prompt diagnosis and initiation of immunosuppressive therapy are crucial for managing this condition.
  • This case series underscores the effectiveness of steroids in treating giant cell aortitis affecting the aorta.