The great imitator

IgG4 periaortitis masquerading as an acute aortic syndrome on computed tomographic angiography

Drew W. Moore, Neil J Hansen, Dominick J DiMaio, William L. Harrison

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

We present the case of a 52-year-old woman who presented to the emergency department with chest and neck pain. Initial cervical spine magnetic resonance imaging shows an abnormal flow void in the left vertebral artery, which prompted a computed tomographic angiogram. This demonstrated a hyperdense thickened ascending aortic wall, which extended into the great vessel origins. Clinically and radiographically interpreted as an acute aortic syndrome and/or intramural hematoma, the patient underwent ascending aortic repair with graft. An unusual aortic and/or periaortic mass was encountered in surgery and final pathology demonstrated IgG4 periaortitis. A rare clinical disease, IgG4-mediated processes are often mimickers of other pathologic entities and frequently lead to misdiagnosis. All pathologically similar, IgG4-mediated disease processes can involve the pancreas, salivary glands, orbits, retroperitoneum, and the vasculature.

Original languageEnglish (US)
Pages (from-to)287-291
Number of pages5
JournalRadiology Case Reports
Volume11
Issue number4
DOIs
StatePublished - Dec 1 2016

Fingerprint

Angiography
Immunoglobulin G
Vertebral Artery
Neck Pain
Orbit
Rare Diseases
Salivary Glands
Diagnostic Errors
Chest Pain
Hematoma
Hospital Emergency Service
Pancreas
Spine
Magnetic Resonance Imaging
Pathology
Transplants

Keywords

  • Acute aortic syndrome
  • Aortitis
  • CT angiography
  • IgG4
  • Intramural hematoma
  • Periaortitis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

The great imitator : IgG4 periaortitis masquerading as an acute aortic syndrome on computed tomographic angiography. / Moore, Drew W.; Hansen, Neil J; DiMaio, Dominick J; Harrison, William L.

In: Radiology Case Reports, Vol. 11, No. 4, 01.12.2016, p. 287-291.

Research output: Contribution to journalArticle

@article{8cde731ebbcd486682327f628a28c0a9,
title = "The great imitator: IgG4 periaortitis masquerading as an acute aortic syndrome on computed tomographic angiography",
abstract = "We present the case of a 52-year-old woman who presented to the emergency department with chest and neck pain. Initial cervical spine magnetic resonance imaging shows an abnormal flow void in the left vertebral artery, which prompted a computed tomographic angiogram. This demonstrated a hyperdense thickened ascending aortic wall, which extended into the great vessel origins. Clinically and radiographically interpreted as an acute aortic syndrome and/or intramural hematoma, the patient underwent ascending aortic repair with graft. An unusual aortic and/or periaortic mass was encountered in surgery and final pathology demonstrated IgG4 periaortitis. A rare clinical disease, IgG4-mediated processes are often mimickers of other pathologic entities and frequently lead to misdiagnosis. All pathologically similar, IgG4-mediated disease processes can involve the pancreas, salivary glands, orbits, retroperitoneum, and the vasculature.",
keywords = "Acute aortic syndrome, Aortitis, CT angiography, IgG4, Intramural hematoma, Periaortitis",
author = "Moore, {Drew W.} and Hansen, {Neil J} and DiMaio, {Dominick J} and Harrison, {William L.}",
year = "2016",
month = "12",
day = "1",
doi = "10.1016/j.radcr.2016.08.006",
language = "English (US)",
volume = "11",
pages = "287--291",
journal = "Radiology Case Reports",
issn = "1930-0433",
publisher = "Elsevier Inc.",
number = "4",

}

TY - JOUR

T1 - The great imitator

T2 - IgG4 periaortitis masquerading as an acute aortic syndrome on computed tomographic angiography

AU - Moore, Drew W.

AU - Hansen, Neil J

AU - DiMaio, Dominick J

AU - Harrison, William L.

PY - 2016/12/1

Y1 - 2016/12/1

N2 - We present the case of a 52-year-old woman who presented to the emergency department with chest and neck pain. Initial cervical spine magnetic resonance imaging shows an abnormal flow void in the left vertebral artery, which prompted a computed tomographic angiogram. This demonstrated a hyperdense thickened ascending aortic wall, which extended into the great vessel origins. Clinically and radiographically interpreted as an acute aortic syndrome and/or intramural hematoma, the patient underwent ascending aortic repair with graft. An unusual aortic and/or periaortic mass was encountered in surgery and final pathology demonstrated IgG4 periaortitis. A rare clinical disease, IgG4-mediated processes are often mimickers of other pathologic entities and frequently lead to misdiagnosis. All pathologically similar, IgG4-mediated disease processes can involve the pancreas, salivary glands, orbits, retroperitoneum, and the vasculature.

AB - We present the case of a 52-year-old woman who presented to the emergency department with chest and neck pain. Initial cervical spine magnetic resonance imaging shows an abnormal flow void in the left vertebral artery, which prompted a computed tomographic angiogram. This demonstrated a hyperdense thickened ascending aortic wall, which extended into the great vessel origins. Clinically and radiographically interpreted as an acute aortic syndrome and/or intramural hematoma, the patient underwent ascending aortic repair with graft. An unusual aortic and/or periaortic mass was encountered in surgery and final pathology demonstrated IgG4 periaortitis. A rare clinical disease, IgG4-mediated processes are often mimickers of other pathologic entities and frequently lead to misdiagnosis. All pathologically similar, IgG4-mediated disease processes can involve the pancreas, salivary glands, orbits, retroperitoneum, and the vasculature.

KW - Acute aortic syndrome

KW - Aortitis

KW - CT angiography

KW - IgG4

KW - Intramural hematoma

KW - Periaortitis

UR - http://www.scopus.com/inward/record.url?scp=84994718778&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84994718778&partnerID=8YFLogxK

U2 - 10.1016/j.radcr.2016.08.006

DO - 10.1016/j.radcr.2016.08.006

M3 - Article

VL - 11

SP - 287

EP - 291

JO - Radiology Case Reports

JF - Radiology Case Reports

SN - 1930-0433

IS - 4

ER -