CASE 14125 Published on 04.10.2016

Aortitis with extrinsic compression of left main trunk: role of cardiac computed tomography

Section

Cardiovascular

Case Type

Clinical Cases

Authors

H. Barahioui[SUP :1], A. soufiani[SUP :1], N. Fellat[SUP :1], R. Fellat[SUP :1], M. Bensaoud2, A. Bayi2, Y. Omor2, S. Moughil2

(1) Department of Cardiology A,
(2) Department of Cardiovascular surgery B,
Ibn Sina hospital, Rabat, Morocco
Patient

43 years, female

Categories
Area of Interest Cardiovascular system ; Imaging Technique CT
Clinical History
A 43-year-old woman without particular medical history presented with unstable angina.
The physical examination found a diastolic murmur of an aortic regurgitation.
The electrocardiogram showed inverted T waves in lateral leads.
Imaging Findings
A cardiac CT scan was realized and revealed a periaortic thickening (panel A) that compressed the left main coronary artery (panel B) and strongly evoked an aortitis.
Blood chemical testing revealed an inflammatory syndrome. Troponin level was normal. All other explorations were negative.
A treatment with steroids was started and the patient underwent surgery. An aortic valve replacement and a coronary bypass (left anterior descending artery - left internal mammary artery) were performed. The pathologist confirmed the diagnosis of a non-specific inflammatory aortitis.
Discussion
Takayasu and Giant-cell arteritis are the two main causes of aortitis. Aortic regurgitation is a frequent complication of this condition. Ostium of the left main trunk stenosis have been reported rarely in patients with rheumatoid arthritis or Takayashu [1].
Cardiac computed tomography (CT) and cardiac computed angiography (CTA) are very attractive for imaging aortitis. CT scan can identify mural thickening, has excellent spatial resolution and represents the gold standard for aortitis evaluation [2-3]. Coronary CTA can identify ostial and proximal coronary stenosis and guide an eventual revascularisation [4-5].
Differential Diagnosis List
Non-specific inflammatory aortitis
Giant-cell arteritis
Takayasu disease
Final Diagnosis
Non-specific inflammatory aortitis
Case information
URL: https://www.eurorad.org/case/14125
DOI: 10.1594/EURORAD/CASE.14125
ISSN: 1563-4086
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