Author + information
- Received June 6, 2017
- Revision received July 13, 2017
- Accepted July 14, 2017
- Published online February 5, 2018.
- Nidaa Mikail, MDa,b,∗ (, )
- Khadija Benali, MDa,b,
- Antoine Dossier, MDc,d,
- Claire Bouleti, MDe,
- Fabien Hyafil, MD, PhDa,b,
- Dominique Le Guludec, MD, PhDa,b,
- François Rouzet, MD, PhDa,b and
- Phalla Ou, MD, PhDb,f
- aDepartment of Nuclear Medicine, Bichat Hospital, Assistance Publique-Hôpitaux de Paris and DHU FIRE, Paris, France
- bInserm Unité Mixte de Recherche U1148, LVTS, Paris-Diderot University, Paris, France
- cDepartment of Internal Medicine, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- dUniversité Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris INSERM U1149 Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation and Remodelling in Renal and Respiratory Diseases), Paris, France
- eDepartment of Cardiology, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- fDepartment of Radiology, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- ↵∗Address for correspondence:
Dr. Nidaa Mikail, Bichat-Beaujon Hospital Nuclear Medicine, 46 rue Henri Huchard, Paris 75018, France.
Infectious aortitis (IA) is a life-threatening disease resulting from the colonization of the aorta wall by pathogenic germs. IA generally occurs in pre-disposing conditions (1): 1) a pre-existing vascular lesion: atheromatous plaques or aneurysm; and/or 2) in immunosuppressed patients, because of either comorbidities or treatments. IA symptoms are inconsistent and unspecific. Diagnosis relies on blood cultures, frequently noncontributive due to previous introduction of antibiotherapy for fever of unknown origin, and on contrast-enhanced computed tomographic angiography (CTA), which implies that the diagnosis was previously suspected. The use of positron emission tomography (PET) using 18F-Fluorodeoxyglucose (18F-FDG) as a tracer (18F-FDG-PET) is widely acknowledged in the management of infectious-related fever, including vascular infections (2). Here we present 4 cases of IA (Figures 1, 2, 3, and 4⇓⇓⇓⇓), illustrating the additional diagnostic value of a sequential multimodal approach combining 18F-FDG-PET for the screening of infections, including IA, followed by oriented CTA for diagnostic confirmation, guided by 18F-FDG-PET results.
IA is a life-threatening disease, the diagnosis of which is difficult, often masked by prior antibiotherapy. 18F-FDG-PET, a mainstay in the work-up of infectious diseases, may display patterns evocative of IA that can be confirmed by CTA. This series suggests IA diagnosis could benefit from a hybrid 18F-FDG-PET/contrast-enhanced CTA imaging.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 6, 2017.
- Revision received July 13, 2017.
- Accepted July 14, 2017.
- 2018 American College of Cardiology Foundation