Tropical diseases Aortic disease
Idiopathic arteritis (Takayasu's disease, or aortic arch arteritis) is unusually common in the tropics but follows the patterns recognised elsewhere. It occurs most frequently in young children and young women, is rare over the age of 30, and may affect any part of the aorta: these factors make a syphilitic aneurysm an unlikely alternative diagnosis. Aortic arteritis is commonly associated with hypertension and can clinically present as an unexpected cerebrovascular accident in a young person. Alternatively, renal failure, obscure abdominal pain or cardiac failure in a young female are other presentations. The anatomical distribution of the vascular disease will dictate the clinical symptoms. The arteritis can
 a |
Figure 35.
Idiopathic arteritis.
a) Upper mediastinum, (AP chest) showing partially calcified aneurysms of the right subclavian artery and descending thoracic aorta. (Nigeria)
b) A pulsatile swelling on the right side of the neck of a patient, with increased blood pressure. The angiogram shows the right common carotid aneurysm, with reduced carotid flow beyond it. (Nigeria)
c) Abdominal angiogram: the same patient as Fig. 35 b. The mid-abdominal aorta is irregular with stenosis of left renal artery. The left kidney is small. (Nigeria)
d) Retrograde aortogram (when passing the catheter from above, it was not possible to get below the level of9-lOth thoracic vertebrae). There is coarctation of the upper abdominal aorta, with a large collateral circulation. (Courtesy of Professor Komolafe, Ilorin, Nigeria)
|
 b
|
 c
|
|
 d
|
|
be multifocal and cause segments of
stenosis or dilatation. It is progressive and can cause complications by narrowing major branches, e.g. a
renal or carotid
artery. Sudden rupture of the
aorta can occur.
Echocardiography and
Doppler ultrasound can monitor the major vessels, but it is also necessary to image the aortic arch and
thoracic aorta. If surgery is considered,
angiography to demonstrate the whole length of the
aorta and the origins of the major branches is essential (Fig. 35).
Philip E.S. Palmer, with Stanley P. Bohrer, Carlos Bruguera, Xing-Rong Chen, Mahmoud R. EImeligi, Hassen A. Gharbi, S.B. Lagundoye, M. W. Wachira