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Journal of the American College of Cardiology Vol. 54, No. 7, 2009© 2009 by the American College of Cardiology Foundation ISSN 0735-1097/09/$36.00P

IMAGES IN CARDIOLOGY

Pulselessness in the Upper ExtremitiesTakayasu ArteritisSebastian Zimmer, MD, Georg Nickenig, MD

Bonn, Germany

rom the Department ofnternal Medicine–ardiology, University ofonn Medical School,onn, Germany.anuscript received

ebruary 20, 2009;ccepted February 25, 2009.

A24-year-old woman was admitted to the hospital by her general practitioner because ofpulselessness in the upper extremities. Except for chronic lower back pain, arthralgia, fa-tigue, and a loud systolic murmur, clinical symptoms were moderate. The initial echocar-

diogram suspected a malformation of the vessels deriving from the aortic arch and showed signs ofconcentric left ventricular hypertrophy. A magnetic resonance angiography of the thoracic aorta,neck, and head revealed the left subclavian (*), common carotid (**), and vertebral (***) arteries trun-cated (A). The right subclavian (°) (A) and vertebral (°°) (B) arteries displayed proximal filiformstenoses. The vessel walls showed massive thickening, and laboratory analyses showed signs of achronic inflammation. Takayasu arteritis was diagnosed, and the patient was treated with glucocor-ticoids. After a mere 5 days of treatment, she reported a dramatic improvement in general condi-tion and a first-time decrease of the chronic back pain. Unfortunately, no improvement in perfusionof the obstructed vessels has been noted thus far (4 weeks).

ublished by Elsevier Inc. doi:10.1016/j.jacc.2009.02.085