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AJNR - American Journal of Neuroradiology

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The Acute Diagnosis of Takayasu's Arteritis Based on Helical CT Angiography of the Chest and Neck in the Emergency Room

Lisa Winer Pinheiro^a, Suzanne D. LeBlang^,a, Jose Romano^a and Alex Forteza^a

^a From the Departments of Radiology (L.W.P., S.D.L.) and Neurology (J.R., A.F.), University of Miami School of Medicine, Miami, FL.

View larger version (104K): [in a new window]   FIG 1. Images from the case of a previously healthy 22-year-old woman who presented to the emergency room with aphasia and right hemiparesis. Axial CT scan, obtained at the aortic arch, reveals thickened walls (arrows).

View larger version (91K): [in a new window]   FIG 2. Axial CT scan, obtained at the level of the great vessels, shows nonopacification of the left common carotid artery (right arrow), indicative of occlusion. The right brachiocephalic artery is not well seen because of streak artifact, but no definite enhancement is seen in the expected location of the vessel (left arrow).

View larger version (123K): [in a new window]   FIG 3. Axial CT scan, obtained at a section higher than that shown in B, shows nonopacification of the left common carotid artery (black arrow) and normal opacification of the right common carotid artery (white arrow). Also noted was delayed opacification of the right vertebral artery (curved black arrow) compared with the left vertebral artery.

View larger version (212K): [in a new window]   FIG 4. Axial CT scan of the mid to upper neck shows contrast opacification in the left internal carotid artery (short arrow) and external carotid artery (long arrow), indicating reconstitution of internal carotid artery flow via retrograde filling of the external carotid artery.

View larger version (142K): [in a new window]   FIG 5. Oblique view of the aortic arch during aortography shows thickening and flattening of the superior wall of the aortic arch (arrowheads). There is no dissection, but study confirms total occlusion at the origin of the left common carotid artery (long arrow), moderate stenosis of the left subclavian artery (curved arrow), and a tight stenosis at the origin of the right brachiocephalic artery (short arrow).