Inflammatory aneurysms of the ascending aorta: diagnosis and surgical treatment

Inflammatory aneurysm of ascending aorta and left anterior descending artery

Background

Inflammatory aortic aneurysms represent less than 5% of ascending aortic aneurysms and are mostly diagnosed intraoperatively. Furthermore, to our knowledge, a case of an accompanying inflammatory LAD aneurysm has not been previously reported.

Case presentation

We report an unusual case of a 42-year-old female with a symptomatic inflammatory aneurysm of the ascending aorta and the LAD. The patient underwent successful resection and replacement of the aneurysm as well as bypass of the LAD.

Conclusions

The underlying etiology of severe inflammatory ascending aortic aneurysms in a previously healthy individual remains unknown. The pre-operative diagnosis is difficult to obtain as it does not have a characteristic appearance on currently available imaging modalities.

IgG4-related Disease: 2013 Update

OPINION STATEMENT

Having diagnosed a patient as having IgG4-related disease, I would have a low threshold for recommending immune-suppressive treatment, and would make that recommendation for any patient with vascular involvement. My initial approach would be prednisone at 40-60 mg/day with a plan to reduce the dose every two weeks, e.g., 40, 30, 20, 15, 10, 7.5, 5, and 2.5 mg for 2 weeks each. In the event of relapse, I would double the current prednisone dose, slow the taper, and add azathioprine, anticipating using that drug for one year if the patient were to remain in remission. In the event or subsequent relapse, I would stop azathioprine and use rituximab. In a patient with large artery involvement, I would consult a vascular surgeon soon after diagnosis, anticipating a need for surgical repair.