144 Takayasu Arteritis

Clinical Presentation

38-year-old woman with weight loss, fever, myalgias, and pulseless left upper extremity

Radiologic Findings

Refer to Figs. 144.1A, 144.1B, 144.1C, 144.1D, 144.1E, 144.1F, 144.1G, 144.1H, 144.1I, 144.1J, 144.1K. Axial HASTE (black blood) (Figs. 144.1A, 144.1B, 144.1C, 144.1D, 144.1E) chest MRI images demonstrate marked narrowing of the left subclavian artery by a thick collar of intermediate signal intensity (Fig. 144.1A). transverse (Figs. 144.1B, 144.1C) ascending and proximal descending (Fig. 144.1D) and distal thoracic aorta (Fig. 144.1E) likewise show a thickened wall of intermediate signal intensity contrasted with the low-signal aortic lumen. Aortic wall thickening is seen to better advantage in the same regions of interest on the post-contrast-enhanced VIBE axial MRI images (Figs. 144.1F, 144.1G, 144.1H). Ten-minute-delayed post-contrast sagittal oblique (Fig. 144.1I) and four-chamber (Fig. 144.1J) images show peripheral enhancement of the thickened aortic wall. 3-D MRA (Fig. 144.1K) reveals luminal narrowing of the brachiocephalic and left common carotid artery and near complete occlusion of the left subclavian artery, which fills via the left vertebral artery. Note the small left common carotid artery aneurysm. Left subclavian steal was confirmed on cine VENC sequences (not illustrated)

Diagnosis

Takayasu Arteritis

Differential Diagnosis

• Large-Vessel Vasculitides of Other Etiologies

Discussion

Background

Takayasu arteritis (aka pulseless disease; aortitis syndrome; idiopathic medial aortopathy) is an idiopathic granulomatous inflammation of the large arteries that may affect the aorta, its great vessels, and the pulmonary arteries. Marked intimal proliferation and fibrosis of the media and adventitia eventually lead to stenosis, occlusion, and, occasionally, post-stenotic dilatations and aneurysm formation. The inflammatory process tends to be segmental with a patchy distribution. Four major types have been described (Table 144.1). The most common

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