Spiral CT Angiography Findings
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⇓).
Takayasu’s arteritis is a well-known systemic disease that involves the aorta, major aortic branches, and pulmonary arteries. Catheter angiography has been considered the best method for disease diagnosis, in correlation with clinical data and laboratory findings. However, recent minimally invasive imaging modalities, such as spiral CT and MRI, provide relevant and accurate vascular assessment. Spiral CT angiography has the advantage of combining morphological mural vessel assessment with luminal abnormality evaluation.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
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