Abstract

Case Report

A 48 year old hypertensive female presented with complaints of retrosternal chest pain with burning sensation and abdominal discomfort. On examination, patient had prominent suprasternal pulsations and absent pulses in left upper limb. Blood pressure was noted to be 150/90 mmHg in right upper limb but could not be measured on left side. Cardiovascular examination revealed a loud S₁ with no associated murmurs, a ‘swishing’ sound was audible over abdominal aorta suggestive of bruit. She denied any complaints of claudication pain in her limbs, joint pains or fever.

Electrocardiograph done showed features of left ventricular hypertrophy and normal sinus rhythm. Chest radiograph revealed prominence of descending thoracic aorta with wall calcifications and focal dilatations [figure 1]. Laboratory investigations like hemogram, serum creatinine, ESR and CRP were normal. A CT Aortogram [figure 2] done revealed complete occlusion of left subclavian artery origin with calcific change at the origin, circumferential irregular wall thickening with circumferential calcifications [involving inner wall] and irregular areas of stenosis seen. Focal erosions of medial wall in distal thoracic aorta were seen. Saccularaneurysm [measuring 8.0 x 7.0 x 7.7mm] arising from infra renal aorta with chronic wall changes was also noted. Severe narrowing of right renal artery with stenosis and a contracted right kidney noted [confirmed on contrast CT: figure 3]. These above mentioned findings were consistent with large vessel arteritis.

A 2 dimensional echocardiography showed concentric left ventricular hypertrophy with no regional wall motion abnormality and ejection fraction of 62%.