case_images: PMC10999319_01
case_images: (A)Pre-treatment contrast Computed tomography angiography reformat showed concentric lesion hypoattenuated with 77 HU and thickening of 1.2 cm at the proximal ascending thoracic aorta. (B) Pre-treatment post-contrast resonance angiography showed a thickened ascending aorta wall (13 mm) with a hypointense signal. (blue arrow). (C) Pre-treatment T1w sequence MR in the same patient demonstrated enhancement of the descending aortic wall after administration of intravenous contrast (white arrow). (D) Pre-treatment Double inversion recovery fat sat T2w sequence MR in the same patient at different levels shows a diffuse hyperintense lesion of the aortic wall compatible with periaortic edema (white arrow).
case_images: apcyccv-5-50-gf1.jpg
case_images: PMC10999319_01_apcyccv-5-50-gf1.jpg
case_images: f1
case_images: This study showed a concentric hypo attenuated and thicked lesion of 1.2 cm at the proximal ascending thoracic aorta and dense tissue with scant enhancement surrounding the aorta compatible with peri aortitis extending from the ascending aorta, aortic arch, subclavian, and infrarenal aorta to the common iliac arteries (Figure 1A). The circumferential involvement was evidenced in the tri-planar image of the thoracic aorta. (Figure 2, video 1). Finally, cardiac magnetic resonance imaging (MRI), in the T1 sequence showed a thickened ascending aorta wall (13mm) with a hypointense signal (Figure 1B) and enhancement of the descending aortic wall after administration of intravenous contrast and in the T2 sequence, evidenced a hyperintense area circumferential to the aorta, extending from the ascending aorta, the aortic arch, and the descending aorta, compatible with an inflammatory process (Figure 1D).
case_images: (A) TEE. Triplanar image of the ascending aorta, the arterial wall with asymmetric thickening of 14 mm in posterior aspect "P", and 8 mm in anterior aspecto "A". (B) TEE. Triplanar image of the descending thoracic aorta, visualizing arterial wall with homogeneous circumferential thickening of 5mm.
case_images: apcyccv-5-50-gf2.jpg
case_images: PMC10999319_01_apcyccv-5-50-gf2.jpg
case_images: f2
case_images: The circumferential involvement was evidenced in the tri-planar image of the thoracic aorta. (Figure 2, video 1).
case_images: (A) Contrast Computed tomography angiography after corticosteroid therapy revealed decreased thickening of the aortic wall of 8.5 cm and attenuation of 50UH. (B) Post-treatment post-contrast resonance angiography revealed a decrease in aortic wall thickness (8mm) with hypointense signal. (blue arrow)
case_images: apcyccv-5-50-gf3.jpg
case_images: PMC10999319_01_apcyccv-5-50-gf3.jpg
case_images: f3
case_images: On the other hand, CT angiography and cardiac MRI revealed an evident decrease in aortic thickness (Figure 3).