Korean Circ J.  2012 Dec;42(12):857-860. 10.4070/kcj.2012.42.12.857.

A Case of Chronic Periaortitis with Retroperitoneal Fibrosis

• Park SH
• Im CH
• Yang DH
• Kang JW
• Yoon JY
• Cho HJ
• Park HS
• Cho Y
• Chae SC
• Jun JE

• KMID: 1491104
• DOI: http://doi.org/10.4070/kcj.2012.42.12.857

Abstract

A 73-year-old man with a history of hypertension and ascending aortic dissection was hospitalized for aggravated abdominal pain and general ache for 3 months. Follow-up CT showed aggravated abdominal aortic hematoma with aneurysm, atherosclerotic periaortitis and bilateral hydronephrosis. An initial laboratory finding showed elevated levels of inflammatory markers and renal dysfunction. Positron emission tomography-CT showed an increased standardized uptake values level in the aortic arch, descending thoracic aorta, major branch, abdominal aorta, and common iliac artery. For bilateral hydronephrosis, a double J catheter insertion was performed. Tissue specimens obtained from previous surgery on the aorta indicated the infiltration of lympho-plasma cells without granuloma formation in the aortic wall. After a combined therapy of high dose steroid therapy with azathioprine, the patient's initial complaints of abdominal pain, weakness and azotemia improved. This case was diagnosed as chronic periaortitis based on aortic inflammation at biopsy, which was complicated with retroperitoneal fibrosis and ureteric obstruction.

Keyword

Periaortitis, chronic; Retroperitoneal fibrosis

MeSH Terms

Abdominal Pain
Aneurysm
Aorta
Aorta, Abdominal
Aorta, Thoracic
Azathioprine
Azotemia
Biopsy
Catheters
Electrons
Follow-Up Studies
Granuloma
Hematoma
Hydronephrosis
Hypertension
Iliac Artery
Inflammation
Retroperitoneal Fibrosis
Ureter
Azathioprine

Figure

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  Fig. 1 Three retrograde pyelographies showing left ureter obstruction (A), right ureter obstruction (B) and post double J catheter insertion state (C).

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  Fig. 2 A computed tomography and a PET CT showing aortic intramural hematoma and FDG uptake at level of thoracic aorta (A and B), descending aorta (C and D) and abdominal aorta (E and F) (the white arrow indicates increased SUV in PET scan image). PET: Positron emission tomography, FDG: Fluorodeoxyglucose, SUV: standardized uptake values.

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  Fig. 3 Hematoxylin and eosin stain of ascending aorta biopsies consist with infiltration of lympho-plasma cells in the media of the aortic wall. Magnified by ×40 (A), ×100 (B), ×200 (C) and ×400 (D).

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