Isolated Aortitis: Workup and Management

Isolated Idiopathic Aortitis in a Young Female Presenting With Exertional Chest Pain: A Case Report

Aortitis is a general term that describes inflammation of the aorta. In most cases, this inflammation is caused by an autoimmune etiology or an infectious etiology. In some instances, the underlying etiology may not be clear, and the diagnosis given is idiopathic aortitis. Cases of idiopathic aortitis are usually diagnosed based on histopathologic findings. Here, we present a case involving a 31-year-old female presenting with acutely worsening exertional shortness of breath and left-sided chest pain. An echocardiogram revealed a severely reduced ejection fraction with severe aortic regurgitation and diffusely increased aortic intima-media thickness. Bioprosthetic aortic valve replacement was performed with histology, showing findings consistent with aortitis, and the patient received the diagnosis of idiopathic aortitis. This case highlights the need to consider aortitis as a differential in young patients presenting with exertional chest pain and severe aortic insufficiency.

Multi-Modality Imaging in Vasculitis

Systemic vasculitides are a rare and complex group of diseases that can affect multiple organ systems. Clinically, presentation may be vague and non-specific and as such, diagnosis and subsequent management are challenging. These entities are typically classified by the size of vessel involved, including large-vessel vasculitis (giant cell arteritis, Takayasu's arteritis, and clinically isolated aortitis), medium-vessel vasculitis (including polyarteritis nodosa and Kawasaki disease), and small-vessel vasculitis (granulomatosis with polyangiitis and eosinophilic granulomatosis with polyangiitis). There are also other systemic vasculitides that do not fit in to these categories, such as Behcet's disease, Cogan syndrome, and IgG4-related disease. Advances in medical imaging modalities have revolutionized the approach to diagnosis of these diseases. Specifically, color Doppler ultrasound, computed tomography and angiography, magnetic resonance imaging, positron emission tomography, or invasive catheterization as indicated have become fundamental in the work up of any patient with suspected systemic or localized vasculitis. This review presents the key diagnostic imaging modalities and their clinical utility in the evaluation of systemic vasculitis.