Double ring sign in Takayasu arteritis

A 21-year-old female presented with chief complaints of abdominal pain and fever for 3  months. Family history was not significant. Her blood pressure was 190/100 mmHg. Auscultation revealed an abdominal bruit but femoral pulses were normal. She had tachycardia (140 beats/min). Laboratory parameters showed elevated inflammatory bio-markers like C-reactive protein (15.0 mg/l) and erythrocyte sedimentation rate (90 mm/h). Computed tomography angiography (CTA) was advised and it revealed significant narrowing of descending aorta due to mural thickening. Venous phase of CTA demonstrated ‘Double ring sign’—a well-enhanced outer ring due to active inflammation in tunica media and adventitial layers and a poorly enhanced internal ring due to swollen intima (Figure 1). This finding is highly suggestive of TA.1 TA is an idiopathic chronic obliterative disorder of large vessels like aorta and is more commonly seen among females. The vessel wall thickness was around 5.4  mm which alone reflects the presence of active disease.2 Diagnosis of TA is difficult since its clinical features overlap with those of other diseases. In the early phase of disease, CTA and magnetic resonance imaging show vessel wall thickening with complications like stenosis, occlusion and aneurysmal dilatation occurring in late phase.2 Other causes of vasculitis include inflammatory aortitis due to syphilis, tuberculosis and Kawasaki disease. Treatment of TA is mainly conservative, most commonly usin...
Source: QJM - Category: Internal Medicine Source Type: research