Teaching Case

50 years old female patient with a history of fever and arthralgia and recent episodes of loss of consciousness. Occlusion of main aortic arch branches on US and MR angiography.

50 years old female patient with a history of fever, weight loss, arthralgia and increased ESR presented with transient loss of consciousness. After ECG Holter monitoring and EEG evaluation, that excluded arrythmic and neurologic et iologies, she underwent US vascular examination followed by MR angiography of the aortic arch, which showed almost complete occlusion of all main aortic branches (Fig. 1). A conventional thoraco-abdominal aortic angiography confirmed the MR findings and showed no other significant vessel stenosis/occlusion. In spite of the surgical indication, the patient refused to be surgically treated.

The presence of main aortic branches involvement in a patient with nonspecific inflammatory signs (fever, increased ESR, myalgia) should raise the suspicion of Takayasu arteritis, a chronic inflammatory panarteritis of unknown pathogenesis usually affecting the aorta and/or its major branches with a clear female prevalence (8:1). After a ÒprepulselessÓ phase lasting up to a year and characterized by nonspecific symptoms, a ÒpulselessÓ phase follows with variable ischemia signs according to the vessel involved.