DÄ internationalArchive24/2020B Symptoms and Gastric Pain

Clinical Snapshot

B Symptoms and Gastric Pain

Dtsch Arztebl Int 2020; 117: 420. DOI: 10.3238/arztebl.2020.0420

Hudowenz, O; Müller-Ladner, U; Klemm, P

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a) CM enhancement in the aortic wall (green arrow), high-grade stenosis at the origin of the celiac trunk due to periaortic soft tissue proliferation (red arrow); b) subtotal reduction in CM enhancement of the aortic wall (green arrow), as well as marked resolution of the periaortic cuff, now with better perfusion of the celiac trunk (blue arrow).
Figures
a) CM enhancement in the aortic wall (green arrow), high-grade stenosis at the origin of the celiac trunk due to periaortic soft tissue proliferation (red arrow); b) subtotal reduction in CM enhancement of the aortic wall (green arrow), as well as marked resolution of the periaortic cuff, now with better perfusion of the celiac trunk (blue arrow).

A 64-year-old female patient presented with B symptoms and postprandial upper abdominal pain of approximately 6 months‘ standing. Gastroscopy was normal. Ultrasound revealed abdominal aortic wall thickening. An unclear periaortic cuff was then seen according to CT morphology. Elevated inflammatory parameters were noted on admission (C-reactive protein [CRP] 2.9 mg/dL, blood sedimentation rate 75 mm). Immunoserology was negative. Complementary MR angiography of the aorta (here: T1 VIBE-Dixon FS with axial CM) revealed significant thickening of the abdominal aortic wall with contrast enhancement in the setting of aneurysmal dilation to 4 cm. Periaortic soft tissue proliferation caused stenosis at the origin of the celiac trunk as a correlate of the postprandial upper abdominal pain. The ureters, renal arteries, and mesenteric arteries were not stenosed. We reached the diagnosis of idiopathic chronic periaortitis while excluding other forms of large vessel vasculitis. Weight-adapted prednisolone and methotrexate therapy was initiated. Over the course of treatment, a response was observed according to clinical, laboratory (CRP 0.4 mg/dL, blood sedimentation rate 25 mm) and morphological imaging criteria.

Ole Hudowenz, Prof. Dr. med. Ulf Müller-Ladner, Dr. med. Philipp Klemm, Abteilung für Rheumatologie und Immunologie, Justus-Liebig-Universität Gießen, Campus Kerckhoff, Bad Nauheim, o.hudowenz@gmx.de

Conflict of interests: Prof. Ladner receives honoraria from Medac for consulting activity. Dr. Klemm and Ole Hudowenz state that there are no conflicts of interest.

Translated from the original German by Christine Rye.

Cite this as: Hudowenz O, Müller-Ladner U, Klemm P: B symptoms and gastric pain. Dtsch Arztebl Int 2020; 117: 420. DOI: 10.3238/arztebl.2020.0420

a) CM enhancement in the aortic wall (green arrow), high-grade stenosis at the origin of the celiac trunk due to periaortic soft tissue proliferation (red arrow); b) subtotal reduction in CM enhancement of the aortic wall (green arrow), as well as marked resolution of the periaortic cuff, now with better perfusion of the celiac trunk (blue arrow).
Figures
a) CM enhancement in the aortic wall (green arrow), high-grade stenosis at the origin of the celiac trunk due to periaortic soft tissue proliferation (red arrow); b) subtotal reduction in CM enhancement of the aortic wall (green arrow), as well as marked resolution of the periaortic cuff, now with better perfusion of the celiac trunk (blue arrow).