Clinical and pathological studies of five autopsied cases of aortitis syndrome. I. Findings of the aorta and its branches, peripheral arteries and pulmonary arteries

Takayasu's arteritis mimicking unilateral pulmonary artery agenesis in a child with severe pulmonary hypertension and right heart failure: a diagnostic dilemma

Affliction of the pulmonary arteries in Takayasu's arteritis is uncommon. Moreover the incidence of pulmonary artery involvement in this condition is often underestimated because of asymptomatic nature in most patients. Severe involvement may however present with pulmonary artery hypertension and hemoptysis, which may prove to be fatal. This case report describes a 9-year-old girl with severe pulmonary hypertension and right heart failure secondary to total occlusion of the right pulmonary artery. Detailed clinical examination and computed tomography (CT) angiography confirmed this diagnosis.

Takayasu's arteritis

The frequency of Takayasu's arteritis (TA) has been estimated to be 2.9 cases per 1 million people, with a female preponderance, although female-to-male ratio varies from different geographic areas. A high frequency of haplotype A24-B52-DR2 has been found in Japanese patients, without this association in other populations. TA has a striking predilection for the aortic arch and its branches. Evidence favors an autoimmune pathogenesis. Segmental inflammation (active and inactive lesions) may coexist. Due to its enhanced resolution, magnetic resonance imaging and magnetic resonance angiography eventually will replace catheterization angiography. Mortality reduction with glucocorticoid treatment has not been firmly established.

Comparative ultrasonographic and angiographic study of carotid arterial lesions in Takayasu's arteritis

The purpose of this study was to compare the usefulness of ultrasonography to that of angiography for studying arterial lesions in Takayasu's arteritis. Ultrasonographic and angiographic findings from 44 carotid arteries of 22 patients with Takayasu's arteritis (2 men and 20 women; mean age, 41.2 years) were compared. Angiography was used to classify the patency of the carotid arteries into three groups: nonstenotic, stenotic, and occlusive. Ultrasonography was also used to classify the same arteries into four groups: nonstenotic, mildly stenotic, moderately stenotic, and occlusive. Thickness of the wall (intima-media complex) of the carotid artery was measured with high-frequency transducers. Angiography showed 23 carotid arteries to be nonstenotic; 12, stenotic; and 9, occlusive; whereas ultrasonography showed 16 to be nonstenotic; 18, mildly stenotic; 7, moderately stenotic; and 3, occlusive. Results of the two diagnostic modalities correlated closely (P < 0.0001). Ultrasonography, aided by color flow imaging, detected six instances of a marginal but definite blood flow that angiography had failed to reveal. Arterial wall thickness correlated closely with the severity of ultrasonographic stenosis (P < 0.005). This thickness was 1.3 +/- 0.4 mm in the nonstenotic group, 1.6 +/- 0.5 mm in the mildly stenotic group, 2.2 +/- 0.8 mm in the moderately stenotic group, and 1.9 +/- 0.2 mm in the occlusive group. Even the walls of the nonstenotic arteries were significantly thicker than those of the normal carotid arteries (0.7 +/- 0.1 mm, P < 0.01). Ultrasonography appeared to be more useful than angiography in estimating stenotic severity of the carotid artery in Takayasu's arteritis. Characteristic ultrasonic findings included luminal stenosis or occlusion on two-dimensional ultrasonograms, decrease in or lack of flow shown by color Doppler flow imaging, and concentric thickening of the carotid arterial walls. Ultrasonographic mural thickness was the most sensitive indicator of early, latent inflammation.

Case report: Therapeutic bronchial artery embolization in a case of Takayasu's arteritis

The pulmonary arteries are frequently involved in Takayasu's arteritis with a reported incidence of 41-100% in affected individuals. Patients are usually asymptomatic, however, often despite extensive pulmonary involvement. We describe a patient with Takayasu's arteritis who presented with haemoptysis caused by bronchial artery hypertrophy secondary to occlusive pulmonary arterial disease, who was treated by bronchial artery embolization. This is, to our knowledge, the first reported case of haemoptysis secondary to Takayasu's arteritis successfully treated by embolization.

Angiographic morphology in nonspecific aortoarteritis (Takayasu’s arteritis): A study of 126 patients from North India

We have studied the angiographic morphology of nonspecific aortoarteritis, or Takayasu's arteritis, in 126 patients who underwent total aortoarteriography by intravenous or intraarterial digital subtraction angiography (DSA). Steno-obstructive lesions were seen in 124 (98.4%) patients and commonly involved the abdominal aorta (76.1%), the renal (67.5%), and the subclavian (56.3%) arteries. They were usually symptomatic. Aneurysms were seen in 16 (12.7%) patients and predominantly involved the descending thoracic aorta (62.5%). They were clinically silent. Localized saccular aneurysms (75%) were more common than the fusiform variety. Asymptomatic pulmonary artery involvement was seen in 11 patients (n = 74; 14.9%). Right lung involvement (72.8%) was more common, usually as a stenosis or occlusion of a lobar branch in the upper zone. Intravenous DSA was usually adequate for establishing the diagnosis. In this population a distinct pattern of involvement and the young age at diagnosis were remarkable.

The incidence and patterns of pulmonary artery involvement in Takayasu's arteritis

The pulmonary arterial anatomy in 44 patients with Takayasu's arteritis was examined by intravenous digital subtraction angiography (IV-DSA) on an outpatient basis using centrally delivered, small-volume, bolus injections of an ionic, water soluble contrast medium. Diagnostic pulmonary angiograms were obtained in 42 patients (95.4%) without complication. Angiographically evident pulmonary arterial involvement was seen in six patients (14.3%). The pulmonary involvement was not suspected clinically in any patient and the chest radiographs were abnormal in only two patients (33%). The angiographic spectrum of systemic arterial involvement was the same irrespective of the presence or absence of pulmonary arterial involvement. The pulmonary arterial pressures were measured in two patients with abnormal pulmonary angiograms and were found normal. Follow up IV-DSA in one of these patients 16 months after immuno-suppressive therapy showed no change in the pulmonary angiographic picture.

Echocardiographic findings in patients with aortitis syndrome

Echocardiography was performed in 18 patients with the aortitis syndrome and in 20 age-matched normal volunteers. The aortic root dimension, the aortic dimension at the level of the sinotubular ridge, the aortic arch dimension, the left ventricular internal dimension, the left atrial dimension, the interventricular septal thickness, and the left ventricular posterior wall thickness were measured. All measurements, except for the left atrial dimension, were significantly greater in patients with aortitis syndrome than in the control subjects. We concluded (1) that the patients with the aortitis syndrome may have an enlarged or narrowed aorta, a dilated left ventricle and left atrium, and a thickened interventricular septum and left ventricular posterior wall; (2) that the incidence and the degree of these abnormalities depend on the presence of complications such as aortic regurgitation and arterial hypertension; and (3) that M-mode as well a cross-sectional echocardiography plays an important role in the assessment of the aorta and heart in the aortitis syndrome.

Morphological findings in idiopathic calcification of the ascending aorta and aortic valve affecting a young woman

The pathology of a case of idiopathic calcification affecting the ascending aorta in a young woman is presented. A varying width of media throughout the aorta and extending into its proximaques of calcium, found in the acellular media, were confined to the ascending aorta. No inflammatory or reparative reaction was seen in the vessel wall. Electron microscopically, the calcium seemed to have an affinity for elastic tissue elements of all sizes and the mode of deposition appeared to be by 'avenues' of the microfibrillar component. Possible pathogenetic mechanisms are discussed.

Baroreflex sensitivity in patients with Takayasu's aortitis

Takayasu's aortitis is an arterial inflammatory disease of arteries of unknown etiology. Fainting is a common symptom and has been attributed to ypersensitivity of the baroreflex. We studied baroreflex sensitivity in 11 patients with Takayasu's aortitis and compared it with that of eight control subjects of comparable age. Baroreflex sensitivity was assessed by determining the slope of a regression line relating the rise of systolic arterial pressure to the prolongation of the R-R interval of the electrocardiogram during a transient rise of arterial pressure induced by an intravenous injection of phenylephrine. The average baroreflex slope of patients with Takayasu's arteritis (4.0 +/- 0.8 msec/mm Hg) was significantly less than that of control subjects (10.7 +/- 0.8 msec/mm Hg, P less than 0.001). Reduced baroreflex sensitivity in patients with Takayasu's aortitis may be due to the hardening of the arteries where baroreceptors lie, or to hypertension and/or cardiac disease which was present in most of the patients included in this study. Patients with Takayasu's aortitis who complained of fainting also showed the reduced baroreflex sensitivity. This indicates that fainting in this disease is not likely to be caused by the hyperreactivity of the baroreceptors as is commonly postulated.

Pulmonary artery involvement in Takayasu's arteritis

Although pulmonary artery disease in Takayasu's arteritis has been described since 1940, it has received little attention. The clinical, hemodynamic, and angiographic features of the pulmonary involvement were studied in 22 patients with systemic arterial disease. Pulmonary involvement was found in 50 percent of the cases. Moderate pulmonary hypertension was a common finding (73 percent). Lesions were generally localized to the large and medium pulmonary vessels. None of the patients had pulmonary symptoms, but in 63 percent there were clinical, radiologic and electrocardiographic findings suggesting pulmonary hypertension or right heart strain. We believe that the pulmonary circulation should be routinely studied in patients with Takayasu's arteritis and that pulmonary involvement should be included in the classification of the disease.