Late Takayasu Arteritis Diagnosis in a Female Patient With Prior Coronary Artery Bypass Grafting

Abstract

Takayasu arteritis is a rare cause of cardiovascular morbidity in the Western world. As consequence, vasculitis may be misdiagnosed and treated as atherosclerotic cardiovascular disease. We present a case of late Takayasu arteritis diagnosis, in a female patient with peripheral artery disease and previous coronary artery bypass grafting. (Level of Difficulty: Intermediate.).

Keywords: MR sequences; MRI, magnetic resonance imaging; TOE, transesophageal echocardiogram; aorta; aortitis; peripheral vascular disease; ultrasound; woman heart.

Graphical abstract

Figure 1

Transthoracic Echocardiogram: Proximal Aorta Wall Thickening Transthoracic echocardiogram– parasternal long axis views focused on the aortic root and proximal ascending aorta, demonstrating echogenic, longitudinal thickening of 4 mm in the aortic root at the level of the sinotubular junction and proximal ascending aorta (yellow arrows).

Figure 2

CTA of Coronary Arteries and Aorta CTA illustrates wall thickening of proximal ascending aorta (red arrows). Ascending aortic dissection is ruled out. Proper image acquisition allows computed tomography pulmonary angiography to be performed without the need for second dose of intravenous contrast administration and concomitantly pulmonary embolism was ruled out. CTA = computed tomography angiography.

Figure 3

TOE: Proximal Aorta Wall Thickening TOE biplane imaging of proximal ascending aorta in 45^o (short axis) (A) and 135^o (long axis) (B) vertical views. A longitudinal and annular thickening is illustrated, which is highly echogenic and homogeneous, with smooth, well-defined borders (yellow arrows). (C) Three-dimensional illustration of proximal ascending aorta. TOE = transesophageal echocardiogram.

Figure 4

MRI: Angiography (A) Concentric and homogeneous thickening of the proximal wall of ascending aorta (red arrows). (B) T2 sequences after fat suppression, with increased signal intensity of the arterial wall (red arrows). (C) T1 sequences just after intravenous gadolinium administration. (D) Ten min after gadolinium administration, late gadolinium enhancement of the aortic wall is observed, a finding consistent with vasculitis (red arrow). (E) Focal stenoses of the left internal and external carotid arteries and of the right subclavian artery are demonstrated (red arrows). MRI = magnetic resonance imaging.