We report a case of 79-year-old woman with an inflammatory aneurysm occurred in a thoracic aorta. The patient was admitted to our medical center because of continuous pyrexia of unknown origin. A marked elevation of serum C-reactive protein level was observed. Infections, collagen vascular diseases and neoplastic disease including malignant lymphoma were found to be unlikely by hematologic, serologic and radiographic examinations. Autoantibodies including antineutrophil antibodies were undetectable. Only enhanced-computed tomography revealed an abnormal finding, so-called mantle core sign, in thoracic aorta, which is specific for inflammatory aortic aneurysm. In general, the disease occurs in abdominal aorta, and the involvement of thoracic aorta like this case is rare. Usually, an aortic aneurysm occurs based on atherosclerotic change of blood vessels, and the aspects of an inflammation of large vessels have been focused recently at the pathological findings, the cytokine profiles and the immunological abnormalities. Thus, the differential diagnosis of the disease from Takayasu arteritis, a prototype of a large vessel vasculitis, is often difficult. The diagnostic procedure to differentiate from the other large vessel vasculitis, Takayasu arteritis and atherosclerotic diseases in abdominal aorta, is discussed.
The patient was given oral prednisolone which lead to favorable outcome.
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