Primary Aortitis: A Diagnostic Mimic of Intramural Hematoma Presenting With Complete Atrioventricular Block.

BACKGROUND

Differential diagnosis between aortitis and intramural hematoma is challenging yet critical. Atypical presentations, including atrioventricular conduction disorders, should raise suspicion of aortitis.

CASE SUMMARY: A 57-year-old man presented with dizziness, aortic regurgitation, and complete atrioventricular block. Computed tomography suggested intramural hematoma, whereas fluorine-18 fluorodeoxyglucose positron emission tomography-computed tomography proved pivotal for the differential diagnosis. Infectious and autoimmune workup was negative. Immunosuppressive therapy led to partial recovery of complete atrioventricular block, but permanent pacing was ultimately required. A diagnosis of primary aortitis was established.

DISCUSSION: Aortitis can display atypical imaging features and may affect the conduction system. To our knowledge, this is the first reported case of primary aortitis presenting with complete atrioventricular block exhibiting conduction improvement after immunosuppressive therapy.

TAKE-HOME MESSAGES: Primary aortitis can mimic intramural hematoma and present with complete atrioventricular block. Multimodal imaging is essential to achieve diagnostic accuracy. Immunosuppression may lead to conduction recovery.