A 24-year-old woman from India presents with claudication of both upper limbs and dizziness on exertion. Brachial and radial pulses are absent bilaterally and a bruit is audible over the left subclavian artery. ESR is 74 mm/hr. Which investigation is MOST appropriate to define the extent of arterial involvement at presentation?
- A Temporal artery biopsy
- B Digital subtraction catheter angiography of the aorta and its branches ✓
- C Duplex ultrasound of the carotid arteries alone
- D CT pulmonary angiogram
Correct answer: B. Digital subtraction catheter angiography of the aorta and its branches
Explanation
This is Takayasu arteritis, a large vessel granulomatous vasculitis of young women characterised by pulselessness, limb claudication and renovascular hypertension. Catheter-based digital subtraction angiography remains the classical gold standard for delineating stenoses, occlusions, aneurysms and collaterals throughout the aorta and its branches. Temporal artery biopsy is reserved for giant cell arteritis in patients over 50 years, and carotid duplex alone would miss aortic and subclavian disease.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.