Cardiovascular Disease: Cardiothoracic Disorders |

Takayasu Arteritis (TA) in a Western, Male, 53-Year-Old Patient FREE TO VIEW

Carlos Latorre Dávila, MD
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Hospital General de Mexico, Ciudad de Mexico, Mexico

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A66. doi:10.1016/j.chest.2016.02.070
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SESSION TITLE: Cardiothoracic Disorders

SESSION TYPE: Case Report Slide

PRESENTED ON: Saturday, April 16, 2016 at 04:00 PM - 05:00 PM

INTRODUCTION: In the Takayasu's disease the obliteration of the innominate, and the carotid and subclavian arteries results from a panarteritis of all layers of the vessel wall, more intensely affected the adventitia and intimal with destruction of vasa vasorum, and cellular infiltration from the lymphocytic series. (1) This peculiar arteritis occurs around the world, although most of the cases have been reported in Asia and Africa with great predilection for young women in which is commonly diagnosed in 1.2 and 2.6 per million populations per year (2).

CASE PRESENTATION: This is a Western patient, male 53-year-old who was admitted because of lower limb intermittent claudication (severe cramping). With a history of syncope 20 years ago, difficulty chewing (weakness of facial muscles), numbness of arms during physical activity, blurred vision that improves during sleep; fatigue, weight loss and night sweats. The patient in this case has clinical features compatible with the TA type I (absence of humeral and radial pulse, low blood pressure in the arms and upper legs and a history of amaurosis fugax and syncope). Blood pressure was identified with brachial-crural dissociation values (80/40 mmHg) in arms (180/100 mmHg) in legs, plus the absence of humeral and radial pulses in both arms and bilateral carotid pulse weak. Fascies that looks older than the actual age.

DISCUSSION: Desease described by Takayasu in 1908; it is also known as asphygmic disease (without pulse), and aorta “inverted” coarctation as well, names that guide the diagnosis. It is known to occur mostly in eastern young women between 15-30 years with a gender ratio of 8: 1 (more women). Although our patient does not fit the age-sex- race profile, was highly predictive of disease the spectrum of signs and symptoms that were present, which added to the images obtained by magnetic resonance, angiography and catheterization, they all lead us to diagnosis.

CONCLUSIONS: Despite the strict profile of Takayasu arteritis, we have demonstrated with our case that can occur in other age and racial groups, factors that are not a reason to ignore the diagnosis. We consider it very important to have a high index of suspicion of the disease from the signs and symptoms of the patient as the beginning, then confirm the diagnosis with additional tests. While our patient was not diagnosed in systemic stage of the disease, but the most distinctive occlusive arteritis phase characteristics led us to the diagnosis.

Reference #1: Stein J. Medicina Interna Diagnostico y Tratamiento. Argentina, Editorial Medica Panamericana. Tercera Edición. 1995. Berkow R. El manual Merck. México, Nueva Editorial Interamericana. Séptima Edición. 1986.

Reference #2: Dufrechou C. Arteritis de Takayasu Revisión de Criterios Diagnósticos y Terapéuticos a propósito de un caso clínico. Rev Med Urug 22(3):236-240.2006. Weyand C M. Medium- and Large Vessel vasculitis N Engl J Med 2003;349:160-169.

DISCLOSURE: The following authors have nothing to disclose: Carlos Latorre Dávila

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