A 28-year-old woman from northern India presents with claudication of both arms, transient visual obscurations, and low-grade fever. Left radial pulse is absent, right is diminished, and there is a bruit over the left supraclavicular fossa. ESR is 68 mm/hr. Which investigation best establishes the diagnosis and extent of disease?
- A Digital subtraction angiography of the coronary arteries
- B MR angiography of the aorta and its major branches ✓
- C Duplex ultrasound of the femoropopliteal arteries
- D Temporal artery biopsy
Correct answer: B. MR angiography of the aorta and its major branches
Explanation
Takayasu arteritis is a granulomatous large vessel vasculitis of the aorta and its primary branches in young women, producing the 'pulseless disease' picture of asymmetric upper limb pulses, bruits and raised inflammatory markers. MR angiography demonstrates the characteristic long-segment stenoses, aneurysms and wall thickening of the arch vessels without radiation, making it the investigation of choice. Temporal artery biopsy diagnoses giant cell arteritis, a disease of patients over 50.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.