https://orcid.org/0009-0002-4651-3947
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Vineeta Ojha, Krishna Prasad Akkineni, Sourabh Agstam, Atit A Gawalkar, Rajiv Narang, A fulminant presentation of Takayasu arteritis complicated by ruptured aortic root abscess, European Heart Journal - Cardiovascular Imaging, 2025;, jeaf108, https://doi.org/10.1093/ehjci/jeaf108
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A 32-year-old male, known hypertensive, presented with dyspnoea on exertion for the preceding 1 month which progressed to severe dyspnoea within 3 days. He had a history of fever for the preceding 2 weeks. On examination, the pulse was not palpable in the left upper limb.
Bedside transthoracic echocardiography showed poor acoustic window and revealed severe eccentric aortic regurgitation. Transoesophageal echocardiography revealed a hypoechoic area at the level of the aortic sinus outside the right coronary and left coronary cusp which was communicating with the left ventricle resulting in diastolic runoff of blood into the left ventricle (Panels A, B and C; asterisk). CT angiography scan revealed the presence of Takayasu arteritis (Numano type IIa) with involvement of branches of the aortic arch and part of the ascending aorta. A double ring sign was appreciated in the arch branches, a marker of active inflammation (Panel D). There was a complex multilobulated thick-walled irregular outpouching (black asterisk) seen communicating with the left coronary cusp (Panel E; white arrow shows peripheral enhancement). It was also seen to communicate with the left ventricle free wall (submitral region) and left ventricular outflow tract (Panels F, H, I; black and white arrows represent the communication). There was minimal external indentation on the proximal left anterior descending artery (Panel G; asterisk), but no significant coronary arterial narrowing was observed. A diagnosis of aortic root abscess in large vessel (Takayasu) arteritis was made.
