Clinical Images: Carotid artery aneurysm with Takayasu arteritis

The patient, a previously healthy 21-year-old man, presented with a two-month history of fever and fatigue. On physical examination, a loud bruit was observed on the patient's left carotid artery; however, tenderness or swelling were absent. Laboratory tests were unremarkable except for elevated C-reactive protein levels. (A) Computed tomography (CT) and three-dimensional CT angiography showed a large left common carotid aneurysm, with a maximum short diameter of 23 mm and wall thickening with peri-wall enhancement in the aortic arch, brachiocephalic artery, left carotid artery, and left subclavian artery. (B) Positron emission tomography (PET)-CT showed accumulations in the same area of the aorta and arteries. Based on these findings, a diagnosis of Takayasu arteritis was made. The patient was treated with a high-dose corticosteroid combined with an anticoagulant, with subsequent alleviation of symptoms. Subsequently, prednisolone was gradually tapered off while methotrexate and tocilizumab were administered, allowing the patient to progress without relapse. Following consultation with a cardiovascular surgeon, anticoagulation therapy was initiated for our patient, with plans for artificial vascular replacement. Takayasu arteritis is a rare form of large vessel vasculitis and typically occurs in young women. Carotid artery aneurysms, an unusual complication of the disease, are reported to occur at a frequency of 1.8% to 3.9%.1 A previous study revealed that Takayasu arteritis with a thrombosed common carotid artery aneurysm may cause an ischemic stroke2; the use of anticoagulants remains under debate. According to expert opinion, the indication for surgery should be based on the consideration of the size of the carotid artery aneurysm, form of the aneurysm, and patient's age. A carotid artery aneurysm with Takayasu arteritis is a rare but critical complication that requires consultation with surgeons to decide the appropriate management plan; therefore, we caution against dismissing this condition. Disclosure form Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.