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Immunoglobulin G4-related multiple cardiovascular lesions successfully treated with a combination of open surgery and corticosteroid therapy  Meikun Kan-o,

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Presentation on theme: "Immunoglobulin G4-related multiple cardiovascular lesions successfully treated with a combination of open surgery and corticosteroid therapy  Meikun Kan-o,"— Presentation transcript:

1 Immunoglobulin G4-related multiple cardiovascular lesions successfully treated with a combination of open surgery and corticosteroid therapy  Meikun Kan-o, MD, PhD, Yuichiro Kado, MD, Atsushi Sadanaga, MD, PhD, Sadafumi Tamiya, MD, PhD, Satoshi Toyoshima, MD, PhD, Masato Sakamoto, MD  Journal of Vascular Surgery  Volume 61, Issue 6, Pages (June 2015) DOI: /j.jvs Copyright © 2015 Society for Vascular Surgery Terms and Conditions

2 Fig 1 A, Initial plain computed tomography (CT) scan demonstrates (left panels) masses around the heart and (right panels) multiple lymphadenopathies. B, Pathologic examination of an axillary lymph node shows (top panel) plasma cell and lymphocyte infiltration with abundant fibrosis (hematoxylin and eosin stain, high magnification) and (bottom panel) several immunoglobulin G4 (IgG4)-positive plasma cells (anti-IgG4 immunostaining, high magnification). C, A three-dimensional image of an enhanced CT scan shows (left panel) a right coronary artery aneurysm (arrow) and (right panel) mass-like wall thickening of the left and right coronary arteries (arrowheads). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

3 Fig 2 A, Thickening is seen on the walls of an infrarenal abdominal aortic aneurysm (AAA) and on the walls of both common iliac arteries (arrowheads). B, Suspicious involvement of the pancreas and kidneys is indicated by pancreatic atrophy, irregular dilatation of the main pancreatic duct, and poorly enhanced pancreatic tail (arrowheads). Multiple poorly enhancing lesions in bilateral kidneys are suggestive of tubulointerstitial nephritis (arrows). C, A right coronary artery aneurysm (arrowhead) and a stenotic lesion of the atrioventricular branch (arrow) are seen on invasive coronary angiography. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

4 Fig 3 A, An intraoperative photograph shows the abdominal aortic aneurysm (AAA) (arrows) and the abnormally thickened wall of the right common iliac artery (arrowheads). B, Histopathologic examination of the resected AAA wall specimen reveals (top panel) lymphoplasmacytic infiltration with fibrosis in the adventitia (hematoxylin and eosin stain, high magnification) and (bottom panel) several immunoglobulin G4 (IgG4)-positive plasma cells (anti-IgG4 immunostaining, high magnification). C, A preoperative computed tomography (CT) scan shows tumor-like wall thickening of the left and right coronary arteries (arrowheads) and aneurysmal dilatation of the right coronary artery (arrow). D, At 4 weeks after the initiation of corticosteroid therapy, reduction in wall thickening of the left and right coronary arteries (arrowheads) and decreased right coronary artery aneurysm (arrow) can be observed. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

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