Giant cell aortitis
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DIFFERENTIAL DIAGNOSIS
Giant cell aortitis Petr Handlos 1,2 & Matěj Uvíra 1,3 & Marek Dokoupil 1,4 & Ondřej Klabal 5 & Klára Handlosová 1 Accepted: 26 February 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Inflammatory aortic diseases are broadly classified into three categories according to the degree of inflammation: atherosclerosis, atherosclerosis with excessive inflammation, and aortitis/periaortitis. This paper presents a case of a 39-year old man with aneurysmal dilatation of thoracic aorta and aortic valve insufficiency. The aortic wall showed thickening and wrinkled “tree bark” appearance as well as apparent scarring of the intima. Histological examination revealed intimal hyperplasia, a granulomatous/giant cell pattern in the inner tunica media, a few epithelioid macrophages, abundant chronic lymphoplasmacytic and histiocytic inflammation and discrete fibrinoid necrosis. The histological findings were indicative of Horton’s disease, but no typical clinical features were present. The case illustrates the difficulties involved in diagnosing inflammatory aortic diseases where it may be challenging to arrive at a specific diagnosis despite the knowledge of medical history, and available macroscopic and histological findings. Keywords Inflammatory aortic diseases . Non-infectious aortitis . Giant cell arteritis . Horton’s disease . Aortic aneurysm
Case report A 39-year old man, with no significant medical history and who worked as a truck driver, collapsed suddenly at work and died, despite timely and professional medical attention. External examination showed obesity (weight of 140 kg) and swelling of the lower limbs. Internal examination revealed enlargement and dilatation of both ventricles, whose section showed small foci of myocardial fibrosis. The atherosclerotic plaque reduced the lumen of the coronary arteries to one third of the normal diameter. The ascending part and part of an arch of thoracic aorta showed aneurysmal dilatation and aortic valve
* Klára Handlosová [email protected] 1
Department of Forensic Medicine, University Hospital Ostrava, CZ-708 52 Ostrava, Czech Republic
2
Department of Intensive Medicine and Forensic Studies, Faculty of Medicine, Ostrava University, CZ-703 00 Ostrava, Czech Republic
3
The Fingerland Department of Pathology, Faculty of Medicine in Hradec Kralove, Charles University, CZ-500 03 Hradec Kralove, Czech Republic
4
Department of Epidemiology and Public Health, Faculty of Medicine, Ostrava University, CZ-703 00, Ostrava, Czech Republic
5
Department of English and American Studies, Faculty of Arts, Palacký University Olomouc, CZ-779 00 Olomouc, Czech Republic
insufficiency. The aneurysm occupied an area from the aortic ring to the brachiocephalic trunk and measured 10 cm in diameter. No other vessels were affected by this phenomenon. The aortic wall showed thickening and wrinkled “tree bark” appearance as well as apparent scarring of the intima (Fig. 1). Histological examination of the proximal ascending aorta u
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