CTICasesTakayasu Arteritis with Coronary Involvement
Imaging findings
A young woman with chest pain and a troponin rise had a non-gated aortic CTA that revealed a left main coronary pseudoaneurysm with a very tight left main stenosis, circumferential aortic wall thickening, and thickening of other vessels including arch branches, a pulmonary artery, and the descending thoracic and abdominal aorta. Subendocardial hypoperfusion of the left main territory indicated active infarction, and she coded during attempted coronary intervention.
Key takeaways
Takayasu arteritis can involve the coronary arteries (classically ostial) and cause a left main pseudoaneurysm and stenosis with active infarction, in the setting of widespread large-vessel wall thickening (aorta, arch branches, pulmonary and vertebral arteries). A teaching point is that vasculitic wall thickening is characteristically circumferential and can be high in attenuation on non-contrast imaging, which distinguishes it from the crescentic high attenuation of intramural hematoma and prevents misdiagnosis as a type A intramural hematoma.
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