Giant cell aortitis masquerading as intramural hematoma

Giant cell aortitis is a rare cause of acute aortic syndrome. We describe the cases of two patients who had presented with chest pain, hypertension, and computed tomography angiographic evidence of mural thickening typical of thoracic aortic intramural hematoma. Although the patients' symptoms improved with hypertension control, elevated inflammatory markers and persistent fever to 103°F raised concern for an inflammatory etiology. Empiric steroids were administered, resulting in prompt cessation of fever and decreasing inflammatory markers. The findings from temporal artery biopsies were positive in both patients. Follow-up axial imaging after 2 weeks of steroid therapy revealed improvement in aortitis with decreased wall thickening. Giant cell aortitis should be considered in patients presenting with acute aortic syndrome in the setting of elevated inflammatory markers and noninfectious fever.