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Weekly Chest CasesArchive of Old Cases

Case No : 1432 Date 2025-03-31

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  • Courtesy of Taehee Lee / Seoul National University Hospital
  • Age/Sex 74 / F
  • Chief ComplaintFever with chest pain. Undergoing chemotherapy for pancreatic cancer
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Pegfilgrastim-induced aortitis
Radiologic Findings
Fig 1-2. Contrast-enhanced chst CT shows diffuse, concentric wall thickening of thoracic aorta.
Fig 3-4. Aortic wall thickening was not observed in chest CT obtained 6 weeks before. Progression of aortic wall thickening is seen in comparison to chest CT taken 4 days before.
Brief Review
Pegfilgrastim, a polyethylene glycol-conjucate granulocyte colony-stimulating factor (G-CSF, filgrastim), is commonly used for the prevention and treatment of chemotherapy-associated neutropenia. Pegfilgrastim has much longer half-life than filgrastim and a single subcutaneous injection can effectively provide neutrophilic effect, therefore, it is increasingly used in the management of patients with cancer.
Aortitis after administration of G-CSF was first reported in 2004. According to a recent study, incidence rate of pegfilgrastim-induced aortitis was 2.7% per patients and 1.2% per doses administered. Pegfilgrastim-inducedaortitis can present with fever, while a majority of patients can be asymptomatic. It occurrs more frequently in patients with esophageal cancer and treated with 5-fluorouracil, cisplatin, or docetaxel. The median time to onset of aortitis after the administration of pegfilgrastim was 9 days.
CT images may show segmental or diffuse wall thickening of aorta, predominantly involving aortic arch and its proximal branches. FDG-PET may show abnormal FDG uptake of aortic wall.
Discontinuation of filgrastim is treatment of choice for the treatment of filgrastim-induced aortitis, while steroid treatment can be considered in patients with persistent aortitis. Aortic dissection is a rare complication of the pegfilgrastim-induced aortitis.
References
1. Takamatsu A, Yoshida K, Toshima F et al. Single-center analysis of pegfilgrastim-induced aortitis using a drug prescription database and CT findings. Radiology 2022;305(3):729-740.
2. Hoshina H, Takei H. granulocyte-colony stimulating factor-associated aortitis in cancer: A systematic literature review. Cancer Treat Res Commun 2021;29:100454.
Keywords

No. of Applicants : 73

▶ Correct Answer : 39/73,  53.4%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - , Japan SUZUNE TSUKAMOTO
  • - IUHW Narita Hospital , Japan ISSEI FUKUDA
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - Kyoto University , Japan AKIHIKO SAKATA
  • - , United Kingdom SAMSON KADE
  • - Kyoto City Hospital , Japan YUSUKE UTSUNOMIYA
  • - Inje University Haeundae Paik Hospital , Korea (South) HYUNGIN PARK
  • - , Korea (South) DONG-HO BANG
  • - , Italy PAOLO BALDASSARI
  • - , Japan CHIAKI SATO
  • - Secomedic Hospital , Japan FUMINORI MIYOSHI
  • - Oita University, Faculty of Medicine , Japan FUMITO OKADA
  • - Seoul Medical Center , Korea (South) HYUK GI HONG
  • - Osaka University , Japan AKINORI HATA
  • - University of Yamanashi , Japan HIROYUKI MORISAKA
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - , Japan YOSHIKI ISHII
  • - , Japan JOJI KURASHIMA
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - , Japan SHUNJIRO NOGUCHI
  • - , Japan MARINO TANIGUCHI
  • - Jichi Medical University, School of Medicine , Japan MITSURU MATSUKI
  • - Shiga General Hospital , Japan YUSAKU MORIBATA
  • - Osaka metropolitan university Hospital , Japan TATSUSHI OURA
  • - Mie university , Japan SHIKO OKABE
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
  • - , Korea (South) SU BEEN LEE
  • - Kyoto University , Japan SHO KOYASU
  • - , Japan SHUHEI NORIMOTO
  • - Seoul National University Bundang Hospital , Korea (South) YOONAH DO
  • - Kyung Hee University Medical Hospital , Korea (South) JEONG TAEK YOON
  • - Fukuoka university , Japan KEISUKE SATO
  • - Kantou Rousai Hospital , Japan KAORU SUMIDA
  • - , Japan YUMI MAEHARA
  • - Toyota Kosei Hospital , Japan YUKI HAYASHI
  • - University of Yamanashi , Japan KOJIRO ONOHARA
  • - , Japan JUN YOSHIDA
▶ Correct Answer as Differential Diagnosis : 3/73,  4.1%
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - University of Yamanashi , Japan TAKAAKI HASHIMOTO
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
▶ Semi-Correct Answer : 10/73,  13.7%
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Hallym University Medical Center , Korea (South) JUNGMIN LIM
  • - , Korea (South) HEONSEOK LEE
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - Holy Family Hospital , India RAJESH GOTHI
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - Samsung Medical Center , Korea (South) SEONGUK KIM
  • - Chonnam Hospital , Korea (South) JAEHYUN PARK
  • - Inje University Pusan Paik Hospital , Korea (South) GEOJEONG SEO
  • - The Catholic University of Korea Yoeuido St. Mary , Korea (South) CHAWOONG JEON
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