Aortic dissection is sometimes lethal. Therefore, accurate and rapid image diagnosis is promptly needed to improve the prognosis. However, the image findings of complication are various. In this review, we present several cases with representative complications of aortic dissection. We also describe typical imaging findings of these complications in patients with aortic dissection.
IgG4-related disease (IgG4-RD) is a recently established disease concept closely associated with elevated serum concentration of IgG4 and abundant IgG4-bearing plasma cell infiltration within affected tissues. The characteristic features of IgG4-RD can be summarized as follows: (1) systemic organ involvement; (2) the ability to involve multiple organs either simultaneously or in a metachronous fashion; (3) imaging findings of swelling, nodules, or increased organ wall thickness; (4) elevated serum IgG4 concentrations; (5) lymphoplasmacytic infiltrate within affected organs, characterized by abundant IgG4-bearing plasma cells; and, (6) favorable response to glucocorticoid therapy in most cases. IgG4 related cardiovascular diseases had been detected during systemic image analysis of other IgG4-RDs, such as autoimmune pancreatitis, and pathological evaluation of surgical specimens, such as aneurysm. At the beginning, these lesions had been recognized as wall thickening of abdominal aorta, and included in the spectrum of retroperitoneal fibrosis. Later, it was evident that these lesions showed systemic vascular distribution, such as thoracic aorta, coronary artery and iliac artery, which resulting in the proposal of the concept of IgG4 related cardiovascular diseases. Extensive studies have been done mainly by 2 approaches, pathological evaluation of surgical specimens and imaging analysis of cases with IgG4-related diseases.
Immunoglobulin G4 (IgG4)-related disease, that is characterized by the elevation of circulating IgG4 level and the tissue-infiltration of IgG4-positive plasma cells, can target the cardiovascular tissue, although the diagnosis of IgG4-related cardiovascular lesion is not easy owing to the substantial risk for the tissue sampling. We herein examined the serum IgG4 levels among cardiac patients. In patients who were admitted to the cardiology department (n=477) and those who underwent computed tomography coronary artery angiography (n=401), elevated serum IgG4 level (≥135 mg/dL) was found 23 (4.8%) and 17 (4.2%), respectively. However, among those with elevated serum IgG4, only two patients could be clinicopathologically diagnosed with IgG4-related disease. Cardiovascular organ involvement may aggravate the prognosis of IgG4-related disease, which in general not life-threatening. Considering that the non-negligible prevalence of high IgG4 level among cardiac patients who were not diagnosed with IgG4-related disease, however, physicians should no count too much on the serum IgG4 levels for the diagnosis of IgG4-related cardiovascular lesions, especially when histopathologic findings are not available, or when other-tissue involvement of IgG4-related disease is not apparent.
We report a case of lethal AMI during EVAR for AAA mediated by an anaphylactic reaction. A man of 60s was indicated for EVAR for hostile abdomen due to the previous laparotomy. The operation was uneventful until sudden ST elevation was noted on ECG monitor just before the final aortogram. He rapidly fell into cardiogenic shock with VF. Intraoperative CAG revealed diffuse spasm with broad thrombotic occlusion of both the LAD and LCX. Immediately, successful PCI were done in Seg. 6 in the LAD in vain. This case is presumed to be the first reported instance of Kounis syndrome during EVAR.
Two patients with intermittent claudication underwent supervised exercise therapy for 2 weeks and received dietary counseling at our hospital. After discharge, they underwent non-supervised exercise therapy with help of our original strength training brochure. They also recorded the daily number of steps, amount of strength training, exercise-induced leg pain, and sleep length in a self-assessment checklist. Initial claudication distance (ICD) and absolute claudication distance (ACD) improved after 2 weeks of supervised exercise therapy. ICD and ACD at 3 months were similar to that at the time of discharge.