A 28-year-old woman from northern India presents with claudication of the upper limbs, absent left radial pulse and an elevated erythrocyte sedimentation rate. Contrast CT angiography shows smooth, long-segment concentric thickening and stenosis of the aortic arch and the origins of the great vessels. What is the most likely diagnosis?

• A Giant cell arteritis
• B Takayasu arteritis ✓
• C Thromboangiitis obliterans
• D Fibromuscular dysplasia

Explanation

Takayasu arteritis is a granulomatous large-vessel vasculitis affecting young women, classically involving the aorta and its major branches with smooth concentric wall thickening and long-segment stenoses, sometimes described as the macaroni sign on ultrasound. Giant cell arteritis shares histology but affects patients over fifty years and favours extracranial carotid branches. Thromboangiitis obliterans involves small and medium vessels of smokers' limbs. Fibromuscular dysplasia gives beading, not smooth wall thickening.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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