AORTIC ARTERITIS



Aortitis is an inflammatory process of the aortic wall that may be caused by several disease pro­cesses, When it involves the origin of various aor­tic branches (e.g., the innominate artery, the left common carotid artery, and the left subclavian ar­tery), it is termed the “aortic arch syndrome” and is characteristically produced by Takayasu’s syn­drome but also by syphilis, arteriosclerosis, or dis­secting aneurysm. Takayasu’s arteritis or pulse­less disease appears to be most common in Japanese females and is an aortic panarteritis that leads to eventual luminal obliteration from the thickened walls and superimposed thrombus. Lo­calized aneurysm formation may occur. The pro­cess may involve the coronary ostia or any of the branches of the aortic arch. Tertiary syphilis causes an aortic arteritis that may lead to an ascending aortic aneurysm, aortic valvulitis with in­sufficiency, and/or coronary ostial stenosis. It is a late manifestation of syphilis, usually occurring 10 to 30 years after the primary infection. Routine serological tests may be negative, but the Trepo­nema pallidum immobilization or the fluorescent Treponemal antibody absorption test are almost always positive. The media of the aorta is de­stroyed from necrosis of smooth muscle and elastic tissue. The intima assumes a wrinkled appearance referred to as “tree barking.” Involvement is much more prominent in the aortic root than in the dis­tal aorta, in contrast to atherosclerotic aortic aneu­rysms. This whole process is often asymptomatic and detected by egg shell calcification of the as­cending aorta on chest x-ray.





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