Chest radiography of a 30-year-old woman with claudication of both upper limbs reveals smooth narrowing of the descending thoracic aortic outline. CT angiography demonstrates circumferential wall thickening of the aortic arch and proximal branches with luminal narrowing of both subclavian arteries. Which imaging feature best separates this entity from giant cell aortitis on angiography?

• A Predominant involvement of young women with upper limb ischaemia ✓
• B Presence of intimal calcification distant from the lumen
• C Saccular outpouching of the ascending aorta only
• D Isolated infrarenal abdominal aortic aneurysm

Explanation

Takayasu arteritis affects women under 40 years and characteristically narrows the aortic arch branches, causing upper limb claudication and absent pulses, whereas giant cell arteritis occurs after age 50 and favours the extracranial carotid territory. Age less than 40 years with subclavian involvement is the discriminating clinical-imaging profile that excludes option B, since intimal calcification is a late nonspecific change.

Reference: Grainger and Allison's Diagnostic Radiology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.