Healed dissection confused with temporal arteritis. Extensive neovascularization--a distinguishing feature

A diagnosis of healed arteritis was made on a right temporal artery biopsy from a 65-year-old woman. She died shortly thereafter despite prednisone therapy. At autopsy, a healing dissection of the entire aorta with extension into the right innominate, right subclavian, right common carotid, right renal, and both iliac arteries was found. There was no underlying aortitis. Review of the temporal artery biopsy showed numerous thick-walled proliferated capillaries in the media of the temporal artery. The stroma was scant and the capillaries were surrounded by endothelial cells. The extensive medial neovascularization represented healed aortic dissection that had extended into the right common carotid, right external carotid, and the right superficial temporal artery. The histologic lesion in dissection is distinctive and should not be confused with temporal arteritis.