CTICasesGiant Cell Arteritis Presenting as Aortitis
Imaging findings
A woman in her 60s with abdominal pain and elevated D-dimer had a PE study and abdominal CT showing no PE but an abnormal aorta with mural thickening and a shaggy luminal interface (aortitis) extending to the common carotids, plus new splenomegaly. Labs showed elevated ESR and CRP, and jaw pain initially attributed to TMJ was actually claudication; a contralateral temporal artery biopsy was normal but did not exclude the diagnosis.
Key takeaways
Aortitis with carotid involvement in an older woman should raise giant cell arteritis, which imaging can bring to attention even with few chest symptoms. Supportive features include elevated inflammatory markers, jaw claudication, headache, and scalp pain; a normal temporal artery biopsy can miss unilateral disease, and confirming the diagnosis matters before committing to high-dose steroids and expensive IL-6 inhibitor therapy. Associated splenomegaly and blood abnormalities here raised the separate possibility of a lymphoproliferative disorder.
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