NONANEURYSMAL AORTOARTERITIS

Aortoarteritis is an uncommon form of retroperitoneal inflammation, wh ich is not associated with an aortic aneurysm or luminal stenosis. The authors report 3 patients with periaortic inflammation whose presenta tions were initially suggestive of a symptomatic aortic aneurysm. All 3 patients had pain, an epigastric mass, and weight loss. The correct diagnosis was suggested by imaging techniques and confirmed by compute rized (CT)-directed needle biopsy in 2 of the patients. Aortic caliber was not altered significantly in any patient. They were all treated w ith corticosteroids with prompt relief of symptoms and rapid resolutio n of the periaortic inflammation as confirmed by CT. There has been no recurrence of symptoms in follow-up. Aortoarteritis appears to-be one expression of the spectrum of inflammatory retroperitoneal diseases a nd is distinct from inflammatory aortic aneurysms and retroperitoneal fibrosis. The authors suggest a logical classification scheme of retro peritoneal inflammation based on the extent of aortic and retroperiton eal involvement. Differentiation between these entities is critical be cause, in contrast to inflammatory aneurysms and retroperitoneal fibro sis involving the aorta, aortoarteritis can be managed without surgery . Magnetic resonance imaging displays the most detail of the periaorti c mass and provides information about intra-aortic flow. Corticosteroi ds are rapidly effective and are the treatment of choice in aortoarter itis when the diagnosis is established.