Agard C, Barrier JH, Dupas B, Ponge T, Mahr A, Fradet G, Chevalet P, Masseau A, Batard E, Pottier P, Planchon B, Brisseau JM, Hamidou MA. Aortic involvement in recent-onset giant cell (temporal) arteritis: a case-control prospective study using helical aortic computed tomodensitometric scan

Internal Medicine, Hôtel-Dieu, Place Alexis Ricordeau, Nantes Cedex 01, France.
Arthritis & Rheumatology (Impact Factor: 7.76). 05/2008; 59(5):670-6. DOI: 10.1002/art.23577
Source: PubMed


The prevalence of the involvement of large vessels in giant cell arteritis (GCA) is 3-13%. Aortitis is the most serious complication of GCA. Computed tomodensitometric (CT) scan allows analysis of both the aortic wall and endoluminal part of the aorta. Therefore, we conducted a study using CT scan to analyze aortic abnormalities in patients with recent-onset GCA.
This prospective controlled study compared patients with biopsy-proven GCA with a matched control group based on sex, age, and cardiovascular risk factors. During the 4-week period following diagnosis of GCA, patients underwent an aortic CT scan. The aortic imaging results were blindly compared between both groups.
From January 5, 1998 to January 11, 1999, 22 patients and 22 controls were screened by CT scan for aortic involvement. Thickening of the aortic wall was more frequent among patients than controls (45.4% versus 13.6%; P = 0.02). Aortic thickening (mean 3.3 mm) was located on the ascending part of the thoracic aorta in 22.7% of the patients, with no evidence of thickening in the controls (P = 0.05). Thickening of the abdominal aortic wall was noted in 27.3% of the patients and none of the controls (P = 0.02).
This study suggests that inflammatory aortic thickening, detected by CT scan, occurs frequently at the time of diagnosis of GCA, and that this condition predominantly occurs on the ascending part of the aorta.

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Available from: Pascal Chevalet, Oct 14, 2014
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    • "Since the previous reports have shown frequent aortic involvement even in the early stages of the disease, it is reasonable that all GCA patients should have an initial diagnostic workup focused on the presence of aortitis, given that GCA aortitis remains largely underestimated. Modern imaging modalities such as PET, MRI or contrast-enhanced CT of the abdomen or chest should be carried for establishing the early diagnosis of GCA aortitis and other aortic abnormalities [15]. In addition, it should be kept in mind that the presentation with classic cranial symptoms and signs of temporal arteritis has been proven to be a negative predictor of an aortic complication. "
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    ABSTRACT: Introduction Giant cell arteritis is the most common form of large-vessel vasculitides. However, it is probable that extracranial involvement is underdiagnosed in patients with classical giant cell arteritis. In the recent literature most cases of giant cell arteritis have been described in conjunction with aortic aneurysms or dissections. Nonetheless the coexistence of giant cell arteritis and retroperitoneal fibrosis is extremely rare. Here, we describe a case of giant cell arteritis at a very early clinical stage, in a woman with coexistence of retroperitoneal fibrosis. Case presentation We report a case of giant cell arteritis at a very early clinical stage, in a 47-year-old Greek woman with coexistence of retroperitoneal fibrosis who was admitted to our hospital with a history of high-grade fever and mild right periumbilical abdominal pain for the past 30 days. In the context of fever of unknown origin, an abdomen computed tomography was ordered. A temporal artery biopsy was also performed because during hospitalization she complained of a headache. Examination of eosin and hematoxylin slides from biopsy specimens of her temporal artery, showed lesions consisting of predominantly lymphocytes, few plasma cells and occasional polymorphonuclear leucocytes. In addition no giant cells were detected in examining biopsies at multiple levels. This was consistent with giant cell arteritis according to the American college of Rheumatology criteria. An abdomen computed tomography revealed the presence of a retroperitoneal soft-tissue mass located anteriorly to the upper infrarenal aorta at the site of the scintigraphic uptake. The computed tomography and magnetic resonance imaging characteristics of the mass were consistent with retroperitoneal fibrosis, and its morphology suggestive of benignity. Our patient started oral prednisolone and was afebrile from day one. Conclusions In our experience this is the first case of retroperitoneal fibrosis due to giant cell arteritis occurring at the same time. Involvement of the aorta (aortitis) and its branches has been also observed in a subset of patients with giant cell arteritis. In addition, giant cell arteritis has been associated with a markedly increased risk of aortic aneurysm particularly thoracic aortic aneurysm.
    Full-text · Article · May 2014 · Journal of Medical Case Reports
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    • "Because aortitis is a complication of GCA, Agard et al., 2008 conducted a study in a series of 22 patients and 22 controls using computed tomodensitometric scan to assess the presence of aortic abnormalities in patients with recent onset GCA. Thickening of the aortic wall was more frequent among patients with GCA than controls (Agard et al., 2008). 18 Fluorodeoxyglucose (FDG)-PET may be useful to detect large vessel arteritis in the setting of GCA, which can involve the larger thoracic, abdominal, and peripheral arteries. "

    Full-text · Chapter · Nov 2011
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    • "Systematic evaluation of patients with large-vessel vasculitis with imaging studies such as color duplex ultrasonography (US), CTA, FDG-PET, angiography, and magnetic resonance imaging (MRI) or MR angiography (MRA) has been performed by several investigators (Agard et al., 2008; Andrews et al., 2004; Andrews & Mason, 2007; Blockmans et al., 2008; Blockmans et al., 2009; Both et al., 2008; Hautzel et al., 2008; Henes et al., 2008; Narvaez et al., 2005; Pipitone et al., 2008; Prieto-Gonzalez et al., 2009; Walter et al., 2005; Webb & Al-Nahhas 2006). These techniques offer different but complementary information to assess large vessel involvement with relative advantages and disadvantages which are summarized in Table 3 (Tso E et al., 2002; Blockmans et al., 2009; Cid et al., 2009; ). "

    Full-text · Chapter · Jul 2011
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