KEY WORDS
Takayasu, common carotid artery stenosis, subclavian artery occlusion,
transthoracic echocardiography
A 36 year old female presented with saddle nose, urticaria and dyspnea.
She was undertreatment for 4 years with Asthma diagnosis. Also she
complained from intermittent claudication in her left arm that kept
worsening gradually. Due to dyspnea and pulselessness in her left arm, a
transthoracic echocardiogram (TTE) was performed and revealed: mild LV
enlargement with severe systolic dysfunction (GEF=15-20%)with no
obvious clot, mild to moderate MR, Thickened tricuspid AV,mild to
moderate AI,Thoracic descending and abdominal aortic flow had normal
flow pattern .Ascending aorta had normal size with turbulent flow at
origin of left carotid artery with increased velocity=3.6cm/sec, with
antegrade diastolic flow suggestive of significant stenosis, left
subclavian artery flow was not seen due to obstraction. There was
systolic turbulent flow at proximal of descending aorta (PG=25mmHg) with
no antegrade diastolic flow suggestive of mild narrowing of descending
aorta with no significant stenosis. In CT angiography Thoracic aorta
showed thickened wall and severe calcification.Left common carotid
artery showed severe stenosis at origin.Left subclavian artery was cut
off from origin and run off before the origin of vertebral artery
(yellow arrow).Left distal subclavian and axillary artery fill via
vertebral artery.Calcification of abdominal aorta with mild ectatic
lumen in infrarenal portion was seen.
Angiography revealed that left internal carotid artery had significant
stenosis (80%) ostial-proximal narrowing with good run off; and left
subclavian artery was totally occluded . Due to unexplained left
ventricular dysfunction , CMR was performed and according to CMR
finding, localized basal inferolateral LV edma and patchy myocardial
fibrosis in favor of acute myocarditis was seen.
She candidate to invasive methods but unfortunately refused. Diuretics,
cellcept and prednisolone were initiated and her discomforts slightly
improved.