ABC | Volume 111, Nº4, Octuber 2018

Image Takayasu Arteritis: From Diagnosis to a Life-Threatening Complication Filipa Cordeiro, Sofia Silva Carvalho, Fernando Salvador, Alberto Ferreira, J. Ilidio Moreira Centro Hospitalar de Trás-Os-Montes e Alto Douro, Hospital de Vila Real, Portugal Mailing Address: Filipa Cordeiro • Rua da Pena, nº420. 4750-693, Barcelos, Braga – Portugal E-mail: filipabritocordeiro@gmail.com Manuscript received December 21, 2017, revised manuscript June 15, 2018, accepted July 23, 2018 Keywords Takayasu Arteritis/surgery; Aortitis/physiopathology; Takayasu Arteritis/diagnostic imaging; Vasculitis. DOI: 10.5935/abc.20180195 A fifty-two-year-old Caucasian woman was admitted for severe epigastric pain irradiating to the back. Physical examination and electrocardiogram were normal. Laboratory tests showed leucocytosis (11100 cells/uL) and increased levels of C-reactive protein (15.6 mg/dl). Due to the suspicion of acute aortic syndrome (AAS), she underwent computed tomography (CT), which showed a low attenuation circumferential mural thickening of the aorta (43 Hounsfield units (HU)), which enhanced (73 HU) after contrast administration (Figures 1 A-C), suggestive of aortitis. 1 Transesophageal echocardiogram also revealed thickened thoracic aorta (Figure 1 D). Cardiovascular magnetic resonance imaging confirmed the diagnosis of aortitis and excluded intramural hematoma (mural thickening hypointense on T1‑weighted images and hyperintense on T2-weighted images) 1,2 (Figures E-F). Infectious serologies were negative. The patient was diagnosed with Takayasu arteritis (TA) at initial inflammatory phase and initiated treatment with high‑dose steroids. There was a reduction of serum inflammatory markers and aortic wall inflammation. Positron emission tomography after fifteen days of therapy showed a discrete tracer uptake in the thoracic aorta (Figure G). After six weeks of treatment, the patient initiated severe back pain. CT angiography showed type A aortic dissection (Figure H). She underwent emergent cardiac surgery, which included resection of ascending aorta, replacement with an artificial graft and obliteration of distal false lumen. Postoperative period was uneventful. TA is a rare, large-vessel vasculitis characterized by an inflammatory phase followed by a pulseless phase. 3,4 Multimodality imaging is useful for diagnosis, which can be challenging due to the similarities with AAS, and follow-up. 1,2 Aortic dissection is an exceptionally rare complication. 5 Author contributions Writing of the manuscript: Cordeiro F; Critical revision of the manuscript for intellectual content: Cordeiro F, Carvalho SS, Salvador F, Ferreira A, Moreira JL. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associatedwith any thesis or dissertationwork. 638