Transient aortitis/periaortitis with spontaneous resolution: Report of four cases

Periaortitis is an inflammatory condition surrounding the aorta, classified as either idiopathic or secondary to well-defined causes; it typically requires treatment with glucocorticoids (GC) and/or immunosuppressants. We report four cases of transient aortitis/periaortitis and summarise their characteristics and clinical courses. The four patients were all women (age range, 37-80 years). All patients had fever; three had dry cough and two experienced back or neck pain near the affected aortic site. At diagnosis, computed tomography revealed eccentric low-density areas in the periaortic space in all cases, involving the aortic arch or descending thoracic aorta in three patients. No carotid artery involvement was observed. One patient received low-dose GC for erythema nodosum, whereas the others did not receive GC or immunosuppressants. The C-reactive protein level was elevated in all cases. Symptoms and the CRP levels typically improved within ~1 month, and follow-up computed tomography performed within ~3 months showed resolution in all cases. These four cases suggest the presence of a transient form of aortitis/periaortitis that improves without high-dose GC or immunosuppressants. Notably, the thoracic aorta was predominantly affected, which is an unusual finding in chronic periaortitis. These cases may overlap with a spontaneous form of isolated aortitis and share informative features with transient perivascular inflammation of the carotid artery syndrome and granulocyte colony-stimulating factor-induced aortitis. Awareness of this condition may reduce unnecessary diagnostic workup and overtreatment; thus, additional case accumulation and further research are warranted to clarify its clinical spectrum and pathogenesis.