Arthritis Research Canada, Richmond, Canada.
Department of Pathology and Laboratory Medicine, Vancouver General Hospital and University of British Columbia, Vancouver, Canada.
Am J Clin Pathol. 2021 Aug 4;156(3):471-477. doi: 10.1093/ajcp/aqaa258.
We present a full autopsy with a focused radiology and pathologic review of the coronary arteries. We hope that the results described in this article will help create better diagnostic measures and prevent future coronary artery vasculitis misdiagnosis.
A full autopsy was performed on the body of Dr Myung Choong Yoon, with full consent from the family, within the department of pathology and laboratory medicine at Vancouver General Hospital. Tissue samples from the heart, brain, lungs, and spinal cord were submitted to specialist pathologists for histologic processing.
Cardiac gated computed tomography coronary angiography suggested periarteritis. Coexistent calcified coronary atherosclerosis with linear calcifications was present along the luminal wall, along with coronary artery ectasia. Histologic assessment confirmed features of dense adventitial fibrosis around the coronary arteries, with an exuberant lymphoplasmacytic infiltrate and numerous plasma cells consistent with IgG4-related disease. The media of the coronary arteries was markedly attenuated or completely absent, which likely contributed to the coronary arterial ectasia noted microscopically. These findings confirmed IgG4-related coronary arteritis.
Coronary periarteritis is an uncommon manifestation of IgG4-related disease established radiographically and later by autopsy.
我们呈现了一具完整尸检，并重点对冠状动脉进行放射学和病理学检查。我们希望本文所描述的结果能有助于制定更好的诊断措施，防止未来误诊冠状动脉血管炎。
在温哥华综合医院病理与医学检验科，经患者家属同意后，对 Myung Choong Yoon 医生的尸体进行了全面尸检。来自心脏、大脑、肺和脊髓的组织样本提交给了病理专家进行组织学处理。
心脏门控计算机断层扫描冠状动脉造影提示血管周围炎。冠状动脉腔内壁伴有线性钙化，同时存在冠状动脉扩张，并存钙化性冠状动脉粥样硬化。组织学评估证实了冠状动脉周围密集的外膜纤维化特征，伴有丰富的淋巴浆细胞浸润和大量浆细胞，符合 IgG4 相关疾病。冠状动脉中层明显变薄或完全缺失，这可能导致显微镜下观察到的冠状动脉扩张。这些发现证实了 IgG4 相关冠状动脉血管炎。
冠状动脉血管周围炎是 IgG4 相关疾病的一种不常见表现，通过放射学检查，然后通过尸检得以确立。
