TA FIGHT: Comprehensive Evaluation of Cardiovascular Complications in a Patient with Takayasu´s Arteritis

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Authors:

Joon-Beom Seo, M.D.,

Tae-Hwan Lim, M.D.,

Department of Radiology, University of Ulsan College of Medicine,

Asan Medical Center, Seoul, Korea

History:

A 50-year-old female patient with a history of known Takayasu´s arteritis was presented with chest discomfort. The patient was diagnosed of Takayasu´s arteritis 20 years ago. She underwent coronary bypass graft surgery 10 years ago for diffuse narrowing of left main (LM), proximal left anterior descending (LAD), and proximal left circumflex (LCx). MSCT examination is requested by the cardiologist for evaluation of her cardiovadcular status.

Diagnosis and Comments:

ECG gated coronary CTA shows patent venous bypass graft which originates from ascending aorta and is anastomosed to distal LAD and diagonal branch [1]. Also shown is diffuse narrowing of left main coronary artery, proximal LAD, and LCx [2]. Non-gated CTA scan obtained immediately after coronary CTA without additional contrast agent shows total occlusion of left subclavian artery, and diffuse severe narrowing of left common carotid artery (LCC) [3]. The LCC originates anomalously from the right brachiocephalic trunk. Diffuse calcification of descending thoracic aorta with narrowing and dilation is also noted, which is the late manifestation of Takayasu´s arteritis. Thin slab MIP image [4] shows occlusion of left lower lobar pulmonary artery due to pulmonary arterial involvement of Takayasu´s arteritis. Also seen are tortuous bronchial arteries and many mediastinal small collaterals entering into left hilum to supply left lower lobe [5]. In the abdomen, mild narrowing of abdominal aorta with calcification at the level of renal artery origin is noted [6].

[1] VRT image shows patent venous bypass graft anastomosed to the distal LAD (arrow) and to diagonal branch (arrowhead) .

[2] VRT image shows diffuse narrowing of left main coronary artery (arrow), proximal LAD (thin arrow), and LCx (arrowhead) .

[3] Narrowing of left common carotid artery (arrow) and total occlusion of left subclavian artery (arrowhead) are seen.

[4] Sagittal slab MIP image shows total occlusion of left lower lobar pulmonary artery.

[5] VRT image shows dense calcification encircling the descending thoracic aorta (arrow) and multiple mediastinal collaterals (arrowheads) .

[6] VRT image of abdominal aorta shows mild narrowing of abdominal aorta with calcified patch at mid level. Diffuse narrowing of right external iliac artery is noted.