We report a case that was diagnosed as neurogenic claudication on clinical features and MRI evidence. However, subsequent to an aortogram the diagnosis was revised. Intermittent claudication is often difficult to distinguish from neurogenic claudication. There are no sensitive discriminators based on history alone. In the presence of poor or absent peripheral pulses, an arteriogram is necessary to ascertain the relative importance of the peripheral arterial circulation.

Summary: A 25 year old Chinese male presented with recurrent attacks of haemoptysis since the age of 14 years. He had a continuous murmur over the right upper chest and signs of pulmonary hypertension which was confirmed at catheterization. Pulmonary angiography and aortagram showed arteritis of the pulmonary vessels and the aorta. Pulmonary involvement in Takayasu's arteritis does occur but is very rare. It is exceptional for a patient to develop pulmonary hypertension and present initially as a case of pulmonary vessels stenosis and occlusion. We describe one such case.