The Use of Contrast-enhanced Ultrasound (CEUS) in Chronic Periaortitis

Introduction

Idiopathic retroperitoneal fibrosis and inflammatory abdominal aortic aneurysms share a similar pathogenesis and can therefore be included under the umbrella term chronic periaortitis (CP). The underlying autoimmune or inflammatory process involves typically the abdominal aorta and the proximal part of the iliac arteries, and might encase adjacent structures leading to clinically relevant obstructions. The idiopathic form of retroperitoneal fibrosis is a rare disease typically affecting men with a mean age between 50 and 60 years and accounts for approximately two-thirds of cases. The remaining secondary forms are attributable to other factors such as neoplasms, infections, drugs, and trauma. Diagnosis of CP is usually suggested by ultrasound and will be confirmed by other cross-sectional imaging modalities including computer tomography (CT) and magnetic resonance imaging (MRI). CT- or MRI-contrast-enhancement is a typical finding supporting the diagnosis of CP by demonstrating the hypervascularized inflammatory tissue surrounding the aortic lumen and to monitor the response to anti-inflammatory and immunosuppressive therapy. In this case report we assessed the utility of CEUS in CP for initial diagnosis and for follow-up after steroid treatment.