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Case Reports in Radiology
Volume 2013 (2013), Article ID 282067, 4 pages
http://dx.doi.org/10.1155/2013/282067
Case Report

The Differential Diagnosis of Two Cases of Chronic Periaortitis

Cardiovascular Center, Tazuke Kofukai Medical Research Institute, Kitano Hospital, 2-2-20 Ogimachi, Kita-ku, Osaka 530-8480, Japan

Received 14 June 2013; Accepted 31 July 2013

Academic Editors: G. Bastarrika, R. Bhargava, and O. Strohm

Copyright © 2013 Takao Kato et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The imaging features of chronic periaortitis resemble those of infected aneurysms. Two illustrative cases of chronic periaortitis, in which the etiologies were caused by IgG4-related disease, are presented. The first case involved a 68-year-old man who presented with vague discomfort in his lower abdomen. The second case was a 42-year-old man who presented with a fever of 38°C and persistent, vague chest discomfort. Both cases demonstrated an increased amount of connective tissue around the aorta in computed tomography images and low intensity in the T2-weighed sequence and high intensity in the diffusion-weighed sequence, suggesting the presence of inflammation, in the magnetic resonance imaging. Negative blood cultures, elevated IgG4 levels, and pathological findings confirmed the diagnosis as chronic periaortitis due to IgG4-related disease. This is a newly recognized syndrome of unknown etiology, characterized by a fibroinflammatory condition, tumefactive lesions, and a dense lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells. Both cases were successfully treated with corticosteroids. Infected aneurysms need to be carefully differentiated from this syndrome in view of the similar imaging features.