Can Takayasu Arteritis Cause Hydronephrosis?

Abstract

A 74-year-old woman was admitted because of malaise and a low-grade fever. Her C-reactive protein level was 0.96 mg/dL. Computed tomography (CT) revealed diffuse uniform thickening of the arterial wall from the abdominal aorta to the common iliac artery and right hydronephrosis. ¹⁸F-fluordesoxyglucose positron emission tomography-CT showed an accumulation in the same area. These findings suggested Takayasu arteritis and retroperitoneal fibrosis as differential diagnoses. Takayasu arteritis is characterized by thickening of the arterial walls, and retroperitoneal fibrosis is characterized by membranous lesions covering the outer surface of the arterial walls. Thus, Takayasu arteritis was deemed the most likely diagnosis. Steroid treatment was effective.

Keywords: 18F-fluordesoxyglucose positron emission tomography; Takayasu arteritis; hydronephrosis; retroperitoneal fibrosis.

Figure 1.

Initial contrast-enhanced computed tomography scan after administration of contrast medium. a: The image shows diffuse uniform thickening (white arrowhead) of the arterial wall from the abdominal aorta to the common iliac artery and dilation of the renal pelvis and ureter (black arrowhead). b: Diffuse uniform thickening (white arrowhead) can be seen in the abdominal aortic wall. c: Dilation of the ureter (black arrowhead) continues to the vicinity of the common iliac artery. d: Magnified image of (c). The black arrowhead shows dilation of the ureter. The white arrow shows the thickened common iliac artery wall. e: ¹⁸F-fluordesoxyglucose positron emission tomography/computed tomography shows the accumulation in the thickened region of the aortic wall (black arrowhead) and the common iliac artery (white arrowhead). f: ¹⁸F-fluordesoxyglucose positron emission tomography/computed tomography shows the accumulation (white arrowhead) in the thickened region (yellow color) of the common iliac arterial wall. The black arrowhead shows the ureteral stent (white color) just before entering the arterial wall. g: ¹⁸F-fluordesoxyglucose positron emission tomography/computed tomography shows the accumulation (white arrowhead) in the thickened region (yellow color) of the common iliac arterial wall. The black arrowhead shows the ureteral stent (white color) entering the arterial wall.

Figure 2.

Computed tomography findings after treatment. a: Right hydronephrosis improved (white arrowhead). b: Wall thickening from the abdominal aorta to the common iliac artery improved (white arrowhead). c: Wall thickening of the abdominal aorta improved (white arrowhead). d: Wall thickening of the common iliac artery improved (white arrowhead).