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The inflammatory abdominal aortic aneurysm. Prevalence, clinical features and diagnostic evaluation
R O Gans1, S J Hoorntje, J A Rauwerda
1Department of Medicine, Free University Hospital, Amsterdam, Netherlands.
The Netherlands Journal of Medicine
|October 1, 1993
Summary
Inflammatory abdominal aortic aneurysms are rare but mimic other conditions. Early diagnosis and surgical repair are key, with caution advised for immunosuppressive therapy.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Rheumatology
Background:
- Inflammatory abdominal aortic aneurysm (iAAA) is a rare subtype of abdominal aortic aneurysm.
- It presents diagnostic challenges due to nonspecific symptoms and resemblance to other conditions.
Observation:
- Eight iAAA patients represented 3.1% of operated aortic aneurysms (1981-1990).
- Common symptoms included abdominal/back pain, elevated erythrocyte sedimentation rate (ESR), and weight loss in some.
- CT scans aided diagnosis in 2 cases, revealing features similar to idiopathic retroperitoneal fibrosis.
Findings:
- The diagnostic triad of symptoms had a low positive predictive value (≤22%).
- Histopathology showed mononuclear leukocyte infiltrates and fibrosis, characteristic of inflammatory processes.
- CT scans are crucial for differentiating iAAA from other conditions, including vasculitis.
Implications:
- Prompt surgical repair of iAAA is recommended.
- Postoperative resolution of inflammation is common.
- Immunosuppressive therapy should be used cautiously due to potential rupture risks.