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Takayasu�s arteritis (TA) is a rare idiopathic chronic inflammatory disease
of unknown aetiology, resulting in a granulomatous panarteritis of the aorta and its major
A 56-year-old women was referred to our Hospital for a chest pain perceived as
pressure-like in quality without dyspnea. The patient described multiple episodes of intermittent
chest pain, fatigue, arthralgias, fever and weight loss of 5 Kg in the last two months. The physical
examination and a chest and abdomen CT were unremarkable. She was in normal sinus
rhythm without signs of ischemia or other ECG abnormalities. A routine laboratory workup
was unremarkable apart from a platelet count of 500,000/Al, C-reactive protein of 15.9 and
Hgb 7.4 g/dl. An echocardiographic study showed areas of crescentic thickening and diffuse
echolucency of ascending aorta and arch
suggestive of diffuse inflammation (Panel A-top). A PET showed an inflammation of the wall of the aorta and subclavian, iliac and
femoral arteries (Panel A-bottom). Therefore, diagnosis of early Takayasu�s arteritis was performed. Oral prednisolone (1 mg/Kg/
day) was administered and tapered
to 5-10 mg/day in two months; the patient had an excellent clinical response. After three months echocardiographic study (Panel
B-top) and PET did not show an inflammation of the aorta and its branches (Panel B-bottom).
Our case is about a non-typical chest pain considered as a pleuro-pericarditis by echocardiografic study, mainly an
inflammation of aortic wall was found.
The use of echocardiographic study and high-resolution Doppler ultrasound was very important to discriminate a pleuro-pericarditis
from a TA earlier.
B-mode ultrasonography clearly demonstrated the characteristic circumferential arterial wall thickening as a �macaroni-like�,
diffusely thickened intima-media complex. In our patient we found areas of crescent thickening and diffuse echolucency of ascending
aorta and arch suggestive of a diffuse inflammation by an echocardiographic study only. However, to confirm a diagnosis, we
F-FDG-PET to detect pre-stenotic disease in patients presenting with non-specific features commonly associated with
TA. We did not perform CT angiography by this technique offers limited imaging of distal aortic branches. The principle advantage
F-FDG-PET is the detection of areas of high glucose metabolic activity in early TA. Indeed, we performed
F-FDG-PET for the
assessment of disease activity and response to treatment.
Our experience suggests that an accurate echocardiographic study and
F-FDG-PET in second time, are important new clinical
tools for the diagnosis of early TA and these may have a place in the monitoring of disease activity and response to treatment.
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