Initial isolated Takayasu's arteritis of the right pulmonary artery: MR appearance

Abstract

Takayasu's arteritis involves the pulmonary artery tree in more than 50% of the cases. Initial isolated involvement of the pulmonary artery by Takayasu's arteritis, however, is very rare. We report the case of a 34-year-old white woman who presented a clinical and radiographic pattern that mimicked an acute pulmonary embolism with pulmonary infarction. Pulmonary angiography showed stenosis lesions and occlusion of the right pulmonary artery tree. Magnetic resonance imaging demonstrated thickening of the pulmonary artery wall leading to the correct diagnosis.

Pulmonary Infarction as the Initial Manifestation of Takayasu's Arteritis

“…In the present case, chest CT and MRI findings were consistent with typical pulmonary artery involvement (5,8,10,12 …”

“…These findings are mostly due to lesions of the aorta and its main branches. Although Takayasu's arteritis frequently involves pulmonary arteries, symptoms rising from pulmonary artery lesions are less frequent (1-3, 6, 7, 13, 14 (5,6,8,9), mainly chest pain, shortness of breath, and hemoptysis. Some misdiagnosed with pulmonary thromboembolism were not treated with corticosteroids for several months to years.…”

“…In addition to the aortic arch and its branches, the pulmonary arteries are also involved in about 50-80% of the patients (1)(2)(3)(4)(5)(6)(7). A relatively small number of reports have referred to symptomatic events associated with pulmonary artery involvement as the initial manifestation at diagnosis, some detailing symptoms due to pulmonary artery obstruction, such as severe dyspnea, which may mimic pulmonary thromboembolism (5,6,8,9). Devouassoux …”

Large Vessel Vasculitis with an Isolated Lesion of a Single-lobe Pulmonary Artery

“…In these cases, multiple pulmonary arteries were involved, and inflammatory markers, such as CRP and ESR, were elevated (4,5). However, the present case had only a single lesion of the lower lobe pulmonary artery and no inflammatory laboratory findings, including CRP and PTX-3 (13).…”

“…A few cases of LVV have been reported in which a pulmonary artery was initially involved (4,5). In these cases, multiple pulmonary arteries were involved, and inflammatory markers, such as CRP and ESR, were elevated (4,5).…”