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(Circulation. 2000;101:345.)
© 2000 American Heart Association, Inc.

Images in Cardiovascular Medicine

Takayasu’s Arteritis

Spiral CT Angiography Findings

Salah D. Qanadli, MD; Jean-François Sissakian, MD; Paulo Rocha, MD; Anne-Marie Piette, MD; Pascal Lacombe, MD

From the Department of Radiology–Cardiovascular Unit (S.D.Q., J.-F.S., P.R., P.L.), Ambroise Paré Hospital, René Descartes University, Paris V and the Department of Internal Medicine (A.-M.P.), CMC Foch, Suresnes, France.

Correspondence to Salah D. Qanadli, Service de Radiologie, Hôpital Ambroise Paré, 9 avenue Charles de Gaulle, 92104 Boulogne-Billancourt Cedex, France. E-mail salah.qanadli@apr.ap-hop-paris.fr

A33-year-old white woman with Takayasu’s arteritis (nonspecific arteritis) diagnosed 14 years earlier developed subacute dyspnea and hemoptysis. She had experienced transient cerebral ischemia 3 weeks before presentation. Spiral CT angiography, performed in a single breath-hold during a 120-mL bolus injection of 24% iodinated contrast material, revealed bilateral stenosis of the pulmonary arteries (Figure 1), occlusion of the innominate brachiocephalic trunk with intraluminal thrombus, and stenosis of the left common carotid artery (Figure 2). Two-dimensional multiplanar reformations and maximum intensity projection reconstructions were helpful in evaluating the occlusive lesions. Furthermore, axial images demonstrated circumferential wall thickening of the aorta and its branches. No additional invasive imaging procedure was required to establish the vessel involvement or determine extent of disease. One month after unsuccessful corticosteroid therapy, the patient underwent surgical repair of pulmonary arterial stenoses and an aorta–right subclavian artery bypass graft. Postoperative spiral CT scan demonstrated no significant residual stenosis of pulmonary arteries and allowed graft patency assessment (Figure 3).

View larger version (128K): [in this window] [in a new window]   Figure 1. Contrast-enhanced CT scan at level of pulmonary arteries. A and B, Axial transverse images show severe bilateral proximal stenosis of pulmonary arteries: 65% stenosis of right pulmonary artery (A, arrow) and 80% stenosis of left pulmonary artery (B, arrow). Furthermore, CT scan demonstrates aortic wall thickening (arrowheads). C, Multiplanar reformatted image in a curved plane along right pulmonary artery. D, Maximum intensity projection reconstruction (caudocranial view) helps provide volumic reconstruction of pulmonary arteries and evaluate degree of stenosis.

View larger version (63K): [in this window] [in a new window]   Figure 2. Contrast-enhanced CT scan at level of supra-aortic vessels. A, Axial . . . [Full Text of this Article]

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