Arteritis Mimicking Aortic Coarctation and Review of the Literature

Abstract

Arteritis is a chronic non-specific inflammation involving the aorta and its main branches, coronary and pulmonary arteries which lead to vascular stenosis or occlusion. Compared with coronary atherosclerosis, primary hypertension and other common cardiovascular disease, arteritis is relatively rare disease. The aortic isthmus arteritist is rarer. Because of a variety of clinical manifestations, there is a little difficulty in early diagnosis and treatment with little experience. An 18-year-old Chinese girl was sent to our hospital for blood pressure 180/70 mmHg in order to confirm the etiology of hypertension. One and a half years ago, she was diagnosed as “bronchiectasis” for hemoptysis and treated by using embolization intervention. Two months ago, she was again diagnosed as iron deficiency anaemia for fatigue. Physical examination discovered that right arm blood pressure was 180/70 mmHg and left arm blood pressure 165/60 mmHg, but double lower limb blood pressure was not measured. Murmur was heard easy in bilateral carotid, subclavian, the back and heart valve auscultation area. However, ultrasound showed normal vascellum in bilateral carotid, subclavian other than decrease of blood flow velocity in double lower limb arteries. The aorta computed tomography angiography scanning found that there was only about 0.45 cm wide in the aortic isthmus with thicker wall. The results of hemoglobin, globulin, C-reaction protein and erythrocyte sedimentation rate were abnormal. The aortic isthmus arteritist and secondary hypertension were clearly diagnosed and treated by using anti-inflammatory, corticosteroids, immunosuppressive agents and antihypertensive drugs until erythrocyte sedimentation rate returned to normal. Finally, artificial vascular was replaced successfully by surgery. Now the patient fells very fine and has already been working for more than two year. This case gives us the inspiration: A detailed examination to patient is very important, which avoid missed diagnosis or misdiagnosis and missed the best opportunity for treatment. As a doctor, we must have solid basic skills and do not underestimate the role of stethoscope in any time. J Med Cases. 2013;4(6):376-379 doi: https://doi.org/10.4021/jmc1251e