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Unexplained chest pain in a patient with giant cell arteritis? Think aortic dissection

Joshua Abishek1, Richard Akintayo2, Chris Isles3

  • 1University of Dundee, Dundee, UK.

The Journal of the Royal College of Physicians of Edinburgh
|September 23, 2022
PubMed

Insights

Giant cell arteritis (GCA) can cause aortic inflammation and dissection. Early large-vessel imaging at diagnosis and follow-up may improve recognition of these serious complications.

Area of Science:

  • Rheumatology
  • Vascular Medicine
  • Medical Imaging

Background:

  • Giant cell arteritis (GCA) is the most frequent large-vessel vasculitis.
  • Aortic inflammation associated with GCA has been recognized for over 80 years.
  • Advanced imaging techniques have enabled systematic study of GCA's impact on the aorta.

Purpose of the Study:

  • To highlight the potential need for routine large-vessel imaging in GCA diagnosis and management.
  • To emphasize earlier recognition of aortitis and its complications, such as aortic dissection.
  • To present a case illustrating the importance of imaging in GCA.

Main Methods:

  • Review of a clinical case involving GCA and aortic complications.
  • Discussion of the role of advanced imaging modalities (CT angiography, MR angiography, PET) in diagnosing aortitis.
  • Analysis of current guidelines (NICE, EULAR) regarding imaging recommendations for GCA.

Main Results:

  • The case underscores that aortic dissection can be a complication of GCA.
  • Current guidelines do not routinely recommend large-vessel imaging for GCA.
  • Sophisticated imaging techniques allow for systematic study and earlier detection of aortic involvement.

Conclusions:

  • Earlier recognition of aortitis in GCA patients is crucial.
  • Routine large-vessel imaging at diagnosis and during follow-up may be warranted.
  • Prompt identification of GCA-associated aortitis and dissection can improve patient outcomes.

Keywords:
aortic dissectiongiant cell arteritislarge-vessel vasculitis

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