Extensive Aortitis with Stanford Type B Intramural Hematoma and Renal Arteritis: A Nuclear Medicine Perspective on Infectious versus Inflammatory Aortitis

Aortitis associated with a Stanford type B intramural hematoma and aortic wall ulcerations requires prompt assessment because both inflammatory and infectious etiologies may produce overlapping imaging findings. We report a 78-year-old woman with poorly controlled hypertension who presented with pulsatile abdominal pain, dyspnea, and vomiting. Marked inflammatory activity was present. 18F-FDG PET/CT demonstrated intense large-vessel uptake, and subsequent CT angiography demonstrated post-isthmic descending aortitis with a Stanford type B intramural hematoma, aortic wall ulcerations, and right renal artery involvement. Treponemal serology was reactive, whereas RPR/VDRL was nonreactive, raising concern for a possible infectious contribution without establishing syphilitic aortitis. The patient subsequently deteriorated, required intensive care, and died shortly thereafter. This case illustrates that inflammatory and infectious aortitis may show overlapping patterns of vascular FDG uptake.