Article Text
Abstract
Clinical introduction A retired 59-year-old woman presented to the cardiology clinic concerned with cardiac pulsations that were visible on her chest wall. These were not associated with dyspnoea, syncope or chest discomfort.
Of note, 8 years previously, she complained of recurrent nocturnal diaphoresis and 5 kg weight loss. Blood sampling at that time revealed a microcytic anaemia, reactive thrombocytosis and raised inflammatory markers (erythrocyte sedimentation rate 99 mm/hour, C-reactive protein 161 mg/L). Following an episode of transient diplopia, ophthalmoscopy demonstrated a cotton wool spot in the left inferotemporal retinal arcade. She commenced a 2-year tapering course of 1 mg/kg prednisolone.
On examination, she had a lean physique with a supine blood pressure of 162/60 mm Hg and palpable Corrigan’s pulse. She had a prominent apical pulsation and a loud early diastolic murmur was present at the left sternal edge radiating to the apex. Echocardiography showed severe central aortic regurgitation and a dilated aortic root (see online supplementary figure 1). Cardiac CT was performed to clarify the diagnosis (figure 1).
Supplementary file 1
Question Which of the following diagnoses best explains this presentation?
Ankylosing spondylitis
Takayasu arteritis
Salmonellosis
IgG4-related aortitis
Giant cell aortitis
Question
- cardiac computer tomographic (ct) imaging
- aortitis
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Footnotes
Contributors AM wrote the manuscript. RP and ADF were involved in the clinical care of the patient.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.