Pulseless Disease with Occlusive Abdominal Aortitis and Hyper tension

Abstract

Since the first description of pulseless disease in young females by Takayasu and Onishi, the disease has been the subject of a large number of case reports and reviews.3-10The fact that involvement of the aortic arch is not pathognomonic of the disease was soon realised. Since then, several cases with involvement of any part of the aorta have been reported.The purpose of this paper is to report two more cases of extensive involvement of the aorta and its branches in young Greek females, presenting as juvenile hypertension. This two patients bring the number of reported cases of pulseless disease in Greece to thirteen. 11-21 CASE I The patient, a young female 22 years old, has been admitted to the hospital for the evaluation of her hypertension, known two years before the admission and discovered during an examination for a skin lesion of the lower limbs. (Figure 1).On admission the blood pressure was 165/100 mmHg and the pulses of the upper limbs were normal. A marked delay of the femoral pulses was noted. Thrills were noted on both sides of the neck. The aucultation of the heart disclosed normal sounds.Systolic ejection murmurs were heard over the carotids and over the abdomen. This last murmur radiated towards the femoral arteries and the lumbar area. The fundi of the eyes were normal and the laboratory findings were equally within normal limits. Tests for venereal disease were negative. Aortographies were performed after injection of Hypaque in two sites, namely at the root of the aorta and the lower part of the thoracic aorta.From Department of Cardiology of King Paul Hospital, Athens, Greece. They were interpreted as follows: There is a stenosis at the beginning of the right common carotid 3-4 cms long, followed by a progressive increase of the diameter of the artery. The left common carotid artery was narrowed in all its length. (Figure 2).The thoracic aorta disclosed a progressive narrowing appearing at the height of the 7th thoracic vertebra. An additional stenosis was visualized 1 cm below the ostia of the renal arteries, 5 cm long, terminating with a poststenotic dilatation. This stenosis showed irregular borders. There was equally a stenosis of the left renal artery (Figure 3). CASE IIThe patient, a 25 year old woman, was admitted for the control of the hypertension discovered during her recent pregnancy. During the labor the systolic blood pressure exceeded 250 mm Hg.On admission her blood pressure was 190/70 mm Hg. There was no palpable pulsations of the left axillar and brachial arteries.The palpation of the neck, disclosed a marked decrease of the pulse amplitude at the left carotid. A delay of the femoral pulse was equally noted. Systolic ejection murmurs were heard over the left carotid. The electrocardiogram showed patterns of left ventricular hypertrophy. The radiological picture of the heart was normal with a moderate increase of the diameter of the ascending aorta. The fundi were normal, and the laboratory findings were equally within normal limits. Serological tests for venereal diseases we...

An Unusual Case of Reno-vascular Hypertension with Multiple Arterial Stenosis

“…[4][5][6][7] This paper reports the case of a 24 year old man of Rumanian origin showing extensive involvement of aorta and its branches. [4][5][6][7] This paper reports the case of a 24 year old man of Rumanian origin showing extensive involvement of aorta and its branches.…”