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Giant cell arteritis in a patient with aortic dissection: a case report
Hiyo Obikane1, Toshiki Fujiyoshi2, Satoshi Takahashi2
1Department of Anatomic Pathology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
Insights
Giant cell arteritis, a large-vessel vasculitis, rarely presents with aortic dissection. This case highlights the importance of considering giant cell arteritis in patients with aortic dissection and specific histopathological findings.
Area of Science:
- Cardiovascular Medicine
- Rheumatology
- Pathology
Background:
- Aortic aneurysms and dissections are known late complications of giant cell arteritis (GCA).
- Large-vessel vasculitis encompasses conditions like GCA and Takayasu arteritis (TA).
- Distinguishing between GCA and TA can be challenging, especially in rare presentations.
Observation:
- A 71-year-old male presented with acute back pain, diagnosed with Stanford type A aortic dissection.
- Surgical repair of the ascending aorta revealed histopathological evidence of aortic dissection and multinucleated giant cell granulomas.
- Granulomas were situated in the aortic media near the intima, with internal elastic lamina destruction.
Findings:
- The patient was diagnosed with GCA, a form of large-vessel vasculitis.
- Histopathological findings differed from Takayasu arteritis, notably lacking feeding vessel stenosis or adventitial fibrosis.
- The diagnosis of GCA in the context of aortic dissection is considered rare.
Implications:
- This case underscores the importance of considering GCA in the differential diagnosis of aortic dissection, particularly in older adults.
- Understanding the histopathological nuances between GCA and Takayasu arteritis is vital for accurate diagnosis.
- Further research may elucidate the specific mechanisms linking GCA to aortic dissection.
Abstract:
Aortic lesions, such as an aortic aneurysm, are known as a late complication that usually occurs several years after the onset of giant cell arteritis. Here, we report a rare case of large-vessel giant cell arteritis in a patient with aortic dissection. A 71-year-old man presented with acute back pain and was diagnosed with aortic dissection, Stanford type A, and he underwent elective ascending aortic replacement. Further studies showed that the resected ascending aorta had aortic dissection and multinucleated giant cell granulomas; the granulomas were located in the media near the intima with partial destruction of the internal elastic lamina; there was no stenosis of the feeding blood vessel or fibrosis of the adventitia as observed in Takayasu arteritis; other types of vasculitis were considered unlikely based on the symptoms and laboratory data. The patient was further diagnosed with giant cell arteritis, which was classified as a large vessel vasculitis along with Takayasu arteritis at the Chapel Hill Consensus Conference in 2012. This is a rare case of giant cell arteritis diagnosed in a patient with aortic dissection. The differences in histopathological findings between Takayasu arteritis and giant cell arteritis are discussed.
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