CTICasesPediatric Takayasu Arteritis with Abdominal Aortic Pseudoaneurysm
Imaging findings
A 3-year-old presenting with concern for glomerulonephritis has a very large heart on radiograph, biventricular dilatation with reduced systolic function, and a left ventricular apical thrombus. The upper abdominal aorta flares out with a lumpy-bumpy, cauliflower/mushroom-shaped, eccentric non-calcified process with areas of both dilatation and stenosis, favoring a pseudoaneurysm, while the thoracic aorta is normal in caliber. There is near-occlusion of the celiac and SMA origins and severe renal artery stenosis (bilateral, with a diseased accessory left renal artery) causing severe hypertension. High-resolution repeat CTA (0.25 mm, 1024 matrix) at lower dose better depicted the patent, stenotic left superior renal artery.
Key takeaways
Presumed Takayasu arteritis in a young child can produce an abdominal aortic pseudoaneurysm with mixed dilatation and stenosis and severe visceral and renal artery involvement, the renal artery stenosis driving severe hypertension and heart failure, even with negative inflammatory markers. The normal-caliber thoracic aorta argues against a coarctation or Williams-type mid-aortic narrowing, and ultra-high-resolution CTA can substantially improve depiction of small stenotic vessels at lower radiation dose.
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