Aortitis pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2] Associate Editor(s)-in-Chief: Maliha Shakil, M.D. [3]

Overview

Aortitis is inflammation or infection of the aortic wall. On gross pathology, characteristic findings of aortitis include a tree-bark appearance and scarring of the aortic media and destruction of the elastic lamina. On microscopic histopathological analysis, extensive intimal and adventitial fibrosis and scarring with resultant luminal narrowing are characteristic findings of aortitis due to Takayasu arteritis. Extensive medial inflammation and necrosis are characteristic findings on microscopic histopathological analysis of aortitis due to giant cell arteritis. The majority of cases of infectious aortitis are due to bacteria seeding through a segment of the aortic wall with existing pathology via the vasa vasorum.

Pathophysiology

Gross Pathology

On gross pathology, characteristic findings of aortitis include:

• A tree-bark appearance
• Scarring of the aortic media and destruction of the elastic lamina

Microscopic Pathology

On microscopic histopathological analysis, characteristic findings of aortitis include:

Cause of Aortitis	Microscopic Histopathologic Features
Takayasu arteritis	Extensive intimal and adventitial fibrosis and scarring Luminal narrowing
Giant cell arteritis	Extensive medial inflammation Medial necrosis
Takayasu arteritis and Giant cell arteritis	Inflammatory cellular infiltrate of the aortic media, adventitia, and vasa vasorum Granuloma formation Multinucleated giant cells
Syphilitic aortitis	Inflammatory infiltrate of the medial and adventitial vasa vasorum Medial necrosis Wrinkled appearance of the intima Small microgummas within the media

Infectious Aortitis

The majority of cases of infectious aortitis are due to bacteria seeding through a segment of the aortic wall with existing pathology via the vasa vasorum. Tuberculous aortitis occurs due to miliary spread or as a result of direct seeding of the thoracic aorta from adjacent infected tissues. Syphilitic aortitis most commonly involves the ascending aorta. Inflammatory involvement of tertiary syphilis begins at the adventitia of the aortic arch which progressively causes obliterative endarteritis of the vasa vasorum. This leads to narrowing of the lumen of the vasa vasorum, causing ischemic injury of the medial aortic arch and then finally loss of elastic support and dilation of the vessel.

References

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