A 26-year-old Asian woman complains of claudication in both arms and transient visual blurring. The radial pulses are absent bilaterally while femoral pulses are strong. ESR is 68 mm/hr. MR angiography shows smooth, tapered stenoses of the arch vessels and descending aorta with normal coronary arteries. What does histopathology of the involved vessel wall characteristically show?

• A Giant cell granulomatous inflammation involving all layers of the wall ✓
• B Fibrinoid necrosis of small and medium muscular arteries
• C Non-inflammatory intimal hyperplasia with lipid-laden foam cells
• D Cystic medial degeneration with loss of elastic fibres

Explanation

Takayasu arteritis is a granulomatous panarteritis of the aorta and its major branches, affecting women under 40, particularly of Asian descent. Histology shows transmural mononuclear infiltrates with multinucleated giant cells, producing fibrous thickening of the intima and adventitia, hence the term pulseless disease. Giant cell arteritis shares the granulomatous pattern but occurs in patients over 50 and favours extracranial branches of the carotid. Polyarteritis nodosa causes fibrinoid necrosis of medium-sized vessels, a completely different picture.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.