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Asymptomatic Takayasu Aortitis Complicated by Type B Dissection

2015; Lippincott Williams & Wilkins; Volume: 132; Issue: 22 Linguagem: Inglês

10.1161/circulationaha.115.017962

1524-4539

Andrea Barison, Cinzia Nugara, Valentina Barletta, Giancarlo Todiere, Elena Montebello, Serena Rossi, Anna Terrizzi, Antonio Tavoni, Giovanni Donato Aquaro,

Dialysis and Renal Disease Management

HomeCirculationVol. 132, No. 22Asymptomatic Takayasu Aortitis Complicated by Type B Dissection Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessResearch ArticlePDF/EPUBAsymptomatic Takayasu Aortitis Complicated by Type B Dissection Andrea Barison, MD, PhD, Cinzia Nugara, MD, Valentina Barletta, MD, Giancarlo Todiere, MD, PhD, Elena Montebello, MD, Serena Rossi, MD, Anna Terrizzi, MD, Antonio Tavoni, MD, PhD and Giovanni Donato Aquaro, MD Andrea BarisonAndrea Barison Scuola Superiore Sant'Anna, Pisa, Italy (A.B.); Fondazione "G. Monasterio" CNR–Regione Toscana, Pisa, Italy (A.B., G.T., G.D.A.); University Hospital Paolo Giaccone, Palermo, Italy (C.N.); Cardiac Thoracic and Vascular Department (V.B.) and Rheumatology Unit (A.Ta.), University of Pisa, Pisa, Italy; Institute of Cardiology, "G. D'Annunzio" University, Chieti-Pescara, Italy (E.M., S.R.); University of Messina, Messina, Italy (A.Te.) , Cinzia NugaraCinzia Nugara Scuola Superiore Sant'Anna, Pisa, Italy (A.B.); Fondazione "G. Monasterio" CNR–Regione Toscana, Pisa, Italy (A.B., G.T., G.D.A.); University Hospital Paolo Giaccone, Palermo, Italy (C.N.); Cardiac Thoracic and Vascular Department (V.B.) and Rheumatology Unit (A.Ta.), University of Pisa, Pisa, Italy; Institute of Cardiology, "G. D'Annunzio" University, Chieti-Pescara, Italy (E.M., S.R.); University of Messina, Messina, Italy (A.Te.) , Valentina BarlettaValentina Barletta Scuola Superiore Sant'Anna, Pisa, Italy (A.B.); Fondazione "G. Monasterio" CNR–Regione Toscana, Pisa, Italy (A.B., G.T., G.D.A.); University Hospital Paolo Giaccone, Palermo, Italy (C.N.); Cardiac Thoracic and Vascular Department (V.B.) and Rheumatology Unit (A.Ta.), University of Pisa, Pisa, Italy; Institute of Cardiology, "G. D'Annunzio" University, Chieti-Pescara, Italy (E.M., S.R.); University of Messina, Messina, Italy (A.Te.) , Giancarlo TodiereGiancarlo Todiere Scuola Superiore Sant'Anna, Pisa, Italy (A.B.); Fondazione "G. Monasterio" CNR–Regione Toscana, Pisa, Italy (A.B., G.T., G.D.A.); University Hospital Paolo Giaccone, Palermo, Italy (C.N.); Cardiac Thoracic and Vascular Department (V.B.) and Rheumatology Unit (A.Ta.), University of Pisa, Pisa, Italy; Institute of Cardiology, "G. D'Annunzio" University, Chieti-Pescara, Italy (E.M., S.R.); University of Messina, Messina, Italy (A.Te.) , Elena MontebelloElena Montebello Scuola Superiore Sant'Anna, Pisa, Italy (A.B.); Fondazione "G. Monasterio" CNR–Regione Toscana, Pisa, Italy (A.B., G.T., G.D.A.); University Hospital Paolo Giaccone, Palermo, Italy (C.N.); Cardiac Thoracic and Vascular Department (V.B.) and Rheumatology Unit (A.Ta.), University of Pisa, Pisa, Italy; Institute of Cardiology, "G. D'Annunzio" University, Chieti-Pescara, Italy (E.M., S.R.); University of Messina, Messina, Italy (A.Te.) , Serena RossiSerena Rossi Scuola Superiore Sant'Anna, Pisa, Italy (A.B.); Fondazione "G. Monasterio" CNR–Regione Toscana, Pisa, Italy (A.B., G.T., G.D.A.); University Hospital Paolo Giaccone, Palermo, Italy (C.N.); Cardiac Thoracic and Vascular Department (V.B.) and Rheumatology Unit (A.Ta.), University of Pisa, Pisa, Italy; Institute of Cardiology, "G. D'Annunzio" University, Chieti-Pescara, Italy (E.M., S.R.); University of Messina, Messina, Italy (A.Te.) , Anna TerrizziAnna Terrizzi Scuola Superiore Sant'Anna, Pisa, Italy (A.B.); Fondazione "G. Monasterio" CNR–Regione Toscana, Pisa, Italy (A.B., G.T., G.D.A.); University Hospital Paolo Giaccone, Palermo, Italy (C.N.); Cardiac Thoracic and Vascular Department (V.B.) and Rheumatology Unit (A.Ta.), University of Pisa, Pisa, Italy; Institute of Cardiology, "G. D'Annunzio" University, Chieti-Pescara, Italy (E.M., S.R.); University of Messina, Messina, Italy (A.Te.) , Antonio TavoniAntonio Tavoni Scuola Superiore Sant'Anna, Pisa, Italy (A.B.); Fondazione "G. Monasterio" CNR–Regione Toscana, Pisa, Italy (A.B., G.T., G.D.A.); University Hospital Paolo Giaccone, Palermo, Italy (C.N.); Cardiac Thoracic and Vascular Department (V.B.) and Rheumatology Unit (A.Ta.), University of Pisa, Pisa, Italy; Institute of Cardiology, "G. D'Annunzio" University, Chieti-Pescara, Italy (E.M., S.R.); University of Messina, Messina, Italy (A.Te.) and Giovanni Donato AquaroGiovanni Donato Aquaro Scuola Superiore Sant'Anna, Pisa, Italy (A.B.); Fondazione "G. Monasterio" CNR–Regione Toscana, Pisa, Italy (A.B., G.T., G.D.A.); University Hospital Paolo Giaccone, Palermo, Italy (C.N.); Cardiac Thoracic and Vascular Department (V.B.) and Rheumatology Unit (A.Ta.), University of Pisa, Pisa, Italy; Institute of Cardiology, "G. D'Annunzio" University, Chieti-Pescara, Italy (E.M., S.R.); University of Messina, Messina, Italy (A.Te.) Originally published1 Dec 2015https://doi.org/10.1161/CIRCULATIONAHA.115.017962Circulation. 2015;132:e254–e255IntroductionA 47-year–old asymptomatic woman underwent routine follow-up of Takayasu aortitis with cardiovascular magnetic resonance. She had undergone aortic valve replacement 7 years before because of aortic root aneurysm. She was normotensive and on chronic therapy with steroids and tocilizumab. In addition, she had undergone yearly clinical follow-ups and a previous cardiovascular magnetic resonance 1 year before, showing mild dilation of the postprosthetic ascending aorta and aortic arch, as well as wall thickening and inflammation of the descending aorta (Figure 1). Her current cardiovascular magnetic resonance scan disclosed a large pseudoaneurysm of the descending aorta, with initial aortic wall dissection (Figure 2 and Movie I, available in the online-only Data Supplement), together with wall thickening, inflammation, and partial thrombotic apposition.Download figureDownload PowerPointFigure 1. Parasagittal magnetic resonance view of the thoracic aorta, performed 1 year before: in steady-state free precession (SSFP) images (A), the postprosthetic ascending aorta and aortic arch were dilated, whereas the descending aorta appeared thickened and mildly dilated; in T2-weighted short-τ inversion recovery (STIR) images (B), the aortic walls appeared thickened and hyperintense because of edema and inflammation, particularly in the descending portion (arrows).Download figureDownload PowerPointFigure 2. Parasagittal magnetic resonance view of the thoracic aorta (performed 1 year after Figure 1): in steady-state free precession (SSFP) images (A), the descending aorta now appeared dilated, with medial wall dissection and 2 large false lumen communicating with the true lumen; in T2-weighted short-τ inversion recovery (STIR) images (B) and in postcontrast late gadolinium enhancement (C) images, the aortic walls appeared thickened and hyperintense because of edema and inflammation (arrows), with thrombosis within the false lumen (asterisk).Takayasu aortitis is an uncommon, idiopathic inflammatory disease, largely affecting the aorta and its main branches. Other than nonspecific inflammatory symptoms, it may be complicated by either ischemic symptoms attributed to stenotic lesions or by aortic wall disruption, dilation, and dissection.1 Diagnostic evaluation of vasculitis relies on noninvasive imaging: color Doppler ultrasound is the method of choice for evaluating epiaortic vessel involvement, whereas computed tomography and cardiovascular magnetic resonance are useful in assessing the thoracic aorta; positron emission tomography imaging allows direct visualization of the extent of vascular inflammation.2 Medical treatment for Takayasu aortitis includes steroids and immunosuppressive drugs; recently, many new biological agents have been discovered for refractory cases, such as the interleukin-6 inhibitor tocilizumab3; the efficacy of endovascular prosthetic treatment is still controversial because of the high rate of restenosis soon after the procedure.1The patient was admitted for clinical evaluation and she underwent computed tomography (Movie II) to confirm the diagnosis and to plan an endovascular prosthetic repair of the descending aorta. Despite optimal medical therapy, the good clinical conditions and the lack of symptoms, serial noninvasive imaging proved of utmost importance to detect disease progression in this patient and to prevent potentially fatal complications.DisclosuresNone.FootnotesThe online-only Data Supplement is available with this article at http://circ.ahajournals.org/lookup/suppl/doi:10.1161/CIRCULATIONAHA.115.017962/-/DC1.Correspondence to Andrea Barison, MD, PhD, Fondazione "G. Monasterio" CNR–Regione Toscana, via Moruzzi, 1–56124 Pisa, Italy. E-mail [email protected]References1. Isobe M.Takayasu arteritis revisited: current diagnosis and treatment.Int J Cardiol. 2013; 168:3–10. doi: 10.1016/j.ijcard.2013.01.022.CrossrefMedlineGoogle Scholar2. Czihal M, Förster S, Hoffmann U.Imaging diagnostics of large vessel vasculitis [in German].Radiologe. 2010; 50:855–860. doi: 10.1007/s00117-010-2001-1.CrossrefMedlineGoogle Scholar3. Loricera J, Blanco R, Castañeda S, Humbría A, Ortego-Centeno N, Narváez J, Mata C, Melchor S, Aurrecoechea E, Calvo-Alén J, Lluch P, Moll C, Mínguez M, Herrero-Beaumont G, Bravo B, Rubio E, Freire M, Peiró E, González-Vela C, Rueda-Gotor J, Pina T, Palmou-Fontana N, Calvo-Río V, Ortiz-Sanjuán F, González-Gay MÁ.Tocilizumab in refractory aortitis: study on 16 patients and literature review.Clin Exp Rheumatol. 2014; 32(3 suppl 82):S79–S89.MedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Wang J, Yao C, Wu Y and Lai B (2020) Asymptomatic long‐segmental type A aortic dissection diagnosed by transthoracic echocardiography: A case report and literature review, Journal of Clinical Ultrasound, 10.1002/jcu.22889, 48:9, (574-578), Online publication date: 1-Nov-2020. Nasim B, Mohammad A, Zafar S, Mathew L, Sajjad A, Shaikh A and Naroo G (2020) Aortic Dissection Differential Diagnosis of Chest Pain, 10.5772/intechopen.89210 Tomelleri A, Campochiaro C, Sartorelli S, Cavalli G, De Luca G, Baldissera E and Dagna L (2019) Gender differences in clinical presentation and vascular pattern in patients with Takayasu arteritis, Scandinavian Journal of Rheumatology, 10.1080/03009742.2019.1581838, 48:6, (482-490), Online publication date: 2-Nov-2019. Sato Y, Kaji S, Ueda H and Tomii K (2017) Thoracic aortitis and aortic dissection following pegfilgrastim administration, European Journal of Cardio-Thoracic Surgery, 10.1093/ejcts/ezx165, 52:5, (993-994), Online publication date: 1-Nov-2017. Yang K, Yang Y, Meng X, Zhang Y, Zhang H, Wu H, Liu Y, Jiang X, Cai J, Zhou X, Hui R, Zheng D and Liu L (2017) Aortic Dissection in Takayasu Arteritis, The American Journal of the Medical Sciences, 10.1016/j.amjms.2017.01.010, 353:4, (342-352), Online publication date: 1-Apr-2017. December 1, 2015Vol 132, Issue 22 Advertisement Article InformationMetrics © 2015 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.115.017962PMID: 26621641 Originally publishedDecember 1, 2015 PDF download Advertisement SubjectsComputerized Tomography (CT)Functional Magnetic Resonance Imaging (fMRI)