Takayasu arteritis presenting with extensive bilateral aneurysms of the common carotid arteries

摘要

A 17-year-old female patient was referred to our institution for vascular evaluation. She had presented to the general practitioner with a sore throat and elevated inflammatory markers. Prior to hospital admission, additional symptoms appeared despite antibiotic treatment: night sweat, cervical pain, and upper extremity claudication.During clinical examination, a whirring bruit audible at auscultation led to subsequent ultrasound of the supraaortic arteries. Figure A shows a sonographic cross-sectional view of a partially thrombosed right common carotid artery (CCA) aneurysm with a maximum diameter of 27.1 mm. As the longitudinal view of the left CCA in Figure B reveals, the wall diameter measured 4.8 mm due to extensive intima-media thickening. By using magnetic resonance angiography (MRA), suspicion of large-vessel vasculitis was substantiated. Magnetic resonance angiography demonstrated a clinical picture pathognomonic for TA with inflammatory vessel wall changes resulting in stenoses (figure C, arrows) and aneurysmatic dilations (figure D, arrows) of the aorta and high-calibre arteries arising thereof.