- Give 500-1000 mg methylprednisolone for adults, or 30 mg/kg methylprednisolone for children.
- If infective aortitis is suspected, obtain blood cultures and give broad-spectrum antibiotics.
- Emergent vascular consultation and intervention are needed if aortic aneurysm, rupture, fistula, or occlusive events are suspected.
Aortitis is characterized by potentially life-threatening inflammation affecting the aorta, ranging from isolated segments to involvement of the entire aorta and its branches. Underlying etiologies include rheumatologic diseases, viral, bacterial, or fungal infections, connective tissue disorders, and drug-related factors. Large-vessel vasculitis, such as giant cell or Takayasu arteritis, is among the most common causes.
The presentation of aortitis varies based on the underlying cause, with symptoms often including nonspecific complaints such as chest, back, or abdominal pain, fever, fatigue, myalgia, and/or arthralgia. Additionally, aortitis can be incidentally discovered in asymptomatic patients. Cardiac involvement may result in new-onset aortic valve insufficiency, congestive heart failure, and angina. Complications can involve embolic and occlusive events, precipitating acute mesenteric ischemia, renal ischemia, limb ischemia, myocardial infarction, and transient ischemic attacks / cerebrovascular accidents. Infectious aortitis can cause pseudoaneurysms (false aneurysms that occur at the site of arterial injury from infection or trauma).
The risk of noninfectious aortitis is heightened in individuals with connective tissue diseases, diabetes, advanced age, and aortic valve pathology. Predictors of infective aortitis include trauma, endocarditis, atherosclerotic disease, and immunodeficiency. Idiopathic aortitis is seen more frequently with female sex and smoking.
