AB0091 Pulmonary takayasu’s arteritis mimicking acute pulmonary embolism
Authors: J Singh, R Brasington
Journal: Annals of the Rheumatic Diseases (2001)

<h3>Background</h3> Pulmonary Takayasu's arteritis may sometimes be the initial presentation of Takayasu's arteritis. Cases of pulmonary TA mimicking chronic thromboembolism have been reported.<sup>1–4</sup> However, only two brief reports of Takayasu's arteritis mimicking acute pulmonary embolism have been described in the radiology and pathology literature,<sup>1,4</sup> but none mentioned the exact duration of symptoms or the detailed presentation. We describe a patient of Takayasu's arteritis who presented with pulmonary symptoms of three days duration, which mimicked acute pulmonary embolism. <h3>Objectives</h3> <h3>Methods</h3> <h3>Results</h3> The patient presented with a three-day history of cough and shortness of breath and had multiple bilateral perfusion defects on ventilation-perfusion scan, typical of acute pulmonary embolism (Figure 1). She was initially diagnosed with acute pulmonary embolism and treated empirically with heparin. Subsequently a negative venous Doppler, absence of changes of acute or chronic thromboembolic disease on pulmonary angiogram, elevated ESR of 70 mm/hr, and the typical angiographic changes (Figure 2), led us to make the correct diagnosis of Takayasu's arteritis. Her initial arch angiogram was normal (Figure 3A) She responded to treatment with prednisone, with both clinical improvement and a 50% increase in the calibre of both right and left pulmonary arteries on a MR angiogram done six months later. A repeat pulmonary angiogram 11 months later showed a decrease in pulmonary artery pressures from 65/12 mm Hg to 49/10 mm Hg. She was lost to follow-up and returned six years later with symptoms of dizziness and angiographic evidence of carotid artery involvement (Figure 3B), which required arterial bypass grafting. Histopathological examination of the artery specimen showed patchy acute and chronic inflammation of adventitia, media and intima, focal granulomatous foreign body reaction, and intimal proliferation, changes consistent with Takayasu's arteritis. <h3>Conclusion</h3> In young women presenting with a clinical picture of acute pulmonary embolism without any risk factors or a previous history of thromboembolism, pulmonary TA must be considered in the differential diagnosis. A careful evaluation of the clinical features, laboratory findings and angiographic appearance, will often lead to the correct recognition of pulmonary Takayasu's arteritis and the initiation of appropriate therapy. <h3>References</h3> Lie JT. Isolated pulmonary arteritis: clinicopathologic characteristics. Mod Pathol 1996;9(5):469–74 Haque U, Hellmann D, Traill T, Venbrux A, Stone J. Takayasu's Arteritis involving proximal pulmonary arteries and mimicking thromboembolic disease. J Rheumatol. 1999;26:450–3 Nakabayashi K, Kurata N, Nangi N, Miyake H, Nagasawa T. Pulmonary artery involvement as first manifestation in three cases of Takayasu's arteritis. Int J Cardiol. 1996;<b>54</b>(Suppl):S147–53 Kerr KM, Auger WR, Fedullo PF, Channick RH, Yi ES, Moser KM. Large vessel pulmonary arteritis mimicking chronic thromboembolic disease. Am J Respir Crit Care Med. 1995;152:367–73