Looking beyond the heart in cardiac magnetic resonance imaging: an interesting case report of Takayasu arteritis presenting with left ventricular apical aneurysm

TL;DR

A case of Takayasu arteritis was diagnosed using cardiac MRI, revealing heart and artery abnormalities beyond typical heart issues.

Contribution

Highlights the importance of comprehensive arterial imaging in diagnosing Takayasu arteritis via cardiac MRI.

Findings

Cardiac MRI revealed an LV apical aneurysm and subclavian artery stenosis in a patient with chest pain.

Imaging of the entire arterial tree confirmed Takayasu arteritis with aorto-arteritis features.

Raised inflammatory markers supported the diagnosis of large vessel vasculitis.

Abstract

Takayasu arteritis (TA), a type of large vessel vasculitis involving the aorta and its major branches, is highly prevalent in Southeast Asian countries. Although cardiac involvement is rare, it is the most common cause of mortality in TA.

Here, we present a case of a 35-year-old woman, with no known previous co-morbidities, who presented with sudden onset acute chest pain and dyspnoea. Twelve-lead electrocardiogram revealed ST-elevation and positive troponin, leading to a clinical diagnosis of ST-elevation myocardial infarction. However, a coronary angiogram showed normal coronaries with an left ventricular (LV) apical outpouching. On table echocardiogram also showed an outpouching from the LV apex. Blood work revealed raised inflammatory markers. For further characterization of the outpouching, a cardiac magnetic resonance imaging (MRI) was done, which revealed an LV apical aneurysm along with ostial stenosis and wall enhancement of bilateral subclavian arteries. Further, the magnetic resonance angiogram showed ostial stenosis of bilateral common iliac origin. The extra-cardiac imaging features of aorto-arteritis, along with raised inflammatory markers led to the diagnosis of TA in this case.

This case report highlights the importance of looking beyond the heart in cardiac MRI. Ostial stenosis and enhancement of bilateral subclavian arteries in led to the imaging suspicion of TA. Further imaging of the entire arterial tree confirmed the diagnosis.

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