A Case of Immunoglobulin G4-Related Inflammatory Thoracic Aortic Aneurysm Diagnosed as Non-communicating Aortic Dissection with Cardiac Tamponade

Abstract

Immunoglobulin G4 (IgG4)-related disease is a systemic inflammatory disease that presents with increases of serum IgG4. IgG4-related aortitis can lead to aneurysms or dissection in the thoracic aorta. We report here a case of IgG4-related aortic aneurysm with cardiac tamponade. A 62-year old man with recurrent vomiting presented to our hospital’s ER. Computed tomography revealed a non-communicating aortic dissection with cardiac tamponade and we planned to perform emergency hemi-arch replacement. Intraoperative finding revealed thickening of the aorta and no aortic dissection. Upon histopathological inspection, an obvious thickening of the aortic wall along with infiltrations of IgG4 positive plasma cells was noted. In addition, serum IgG4 exceeded baseline values, and such this patient was diagnosed with an IgG4-related inflammatory thoracic aortic aneurysm.