Multiple Pulmonary Artery Aneurysms and Pulmonary Hypertension in a Patient with Takayasu Arteritis: Case Report and Review of Literature

Yıl 2009, Cilt: 3 Sayı: 1, 54 - 58, 19.03.2009

Gökhan Aykun

Öz

Takayasu arteritis, also known as pulseless disease, is a rare inflammatory vascular disease which primarily affects the aorta and its major branches. Vessel inflammation leads to wall thickening, fibrosis and stenosis. More severe inflammation can destroy the arterial media and lead to aneurysm formation. The clinical features of this disease are quite variable, depending on the involvement location. Typical features relate to systemic arteries involvement. Although clinically systemic symptoms are more clear, pulmonary vasculary disease occurs in an important ratio of patients. But, it has been reported in little cases whose pulmonary vascular involvement is determining factor in prognosis. We present a patient who complains of dyspnea for 3 years, has established multiple Pulmonary artery aneurysms and widespread thrombosis in his peripheral arterial vessels and has been diagnosed as Takayasu arteritis.

Anahtar Kelimeler

Takayasu arteritis; multiple pulmonary artery aneurysms; pulmonary hypertension

Multiple Pulmoner Arter Anevrizmaları ve Pulmoner Hipertansiyonu Olan Takayasu Arteritli Bir Hasta: Olgu Sunumu ve Literatür Derlemesi

Öz

Nabızsızlık hastalığı olarak da bilinen Takayasu Arteriti, aort ve onun major dallarını tutan nadir görülen inflamatuar bir damar hastalığıdır. Damar inflamasyonu duvar kalınlaşması, fibrozis ve stenoza neden olur. Daha şiddetli inflamasyon arterin media tabakasını tahrip edebilir ve anevrizma gelişmesine neden olabilir. Klinik özellikleri, hastalığın tuttuğu yere göre tamamen farklılık gösterir. Tipik özellikleri sistemik arter tutulumuna bağlıdır. Hastalığın sistemik bulgularının klinik olarak daha belirgin olmasına karşın pulmoner vasküler tutulum hastaların önemli bir kısmında oluşur. Fakat pulmoner vasküler tutulumun prognozda belirleyici olduğu az sayıda vaka bildirilmiştir. Burada, 3 yıldır olan nefes darlığı şikayeti ile başvuran ve pulmoner hipertansiyon, multiple pulmoner arter anevrizmaları ve periferal arteryel damarlarında yaygın trombüsleri saptanan ve takayasu arteriti tanısı konulan bir olgu sunuldu.

Dr. Gökhan AYKUN, Dr. Ayşegül KARALEZLİ, Dr. Mükremin ER, Dr. H. Canan HASANOĞLU

Anahtar Kelimeler

Takayasu arteriti; multiple pulmoner arter anevrizması; pulmoner hipertansiyon, Takayasu Arteritli, Arter Anevrizmaları

Kaynakça

• 1. Johnston SL, Lock RJ, Gompels MM. Takayasu arteritis: a review. J Clin Pathol 2002; 55(7):481-6.
• 2. Yamada I, Shibuya H, Matsubara 0, Umehara I, Makino T, Numano F, et al. Pulmonary artery disease in Takayasu’s arteritis: angiographic findings. AJR Am J Roentgenol 1992; 159(2):263-9.
• 3. Brugiere 0, Mal H, Sleiman C, Groussard 0( Mellot F, Fournier M. Isolated pulmonary arteries involvement in a patient with Takayasu's arteritis. Eur Respir J 1998; 11(3)767-70.
• 4. Neidhart B, Kosek R, Bachmann LM, Stey C. Exertional dyspnea as initial manifestation of Takayasu's arteritis: A case report and literature review. BMC Pulm Med 2001 ;1:3.
• 5. Kerr GS, Hallahan CW, Giordano J, Leavitt RY, Fauci AS, Rottem M, et al. Takayasu arteritis. Ann Intern Med 1994;120(11):919-29.
• 6. Eichhorn J, Sima D, Thiele B, Lindschau C, Turowski A, Schmidt H, et al. Anti-endothelial cellantibodies in Takayasu arteritis. Circulation 1996;94(10):2396-401.
• 7. Lie JT. Takayasu's arteritis. In: Churg A, Churg J, eds.Systemic vasculitides. New York, Igaku-Shoin 1991. p. 159-79.
• 8. Lupi E, Sanchez G, Horowitz S, Gutierrez E. Pulmonary artery involvement in Takayasu's arteritis. Chest 1975;67(1):69-74.
• 9. Vanoli M, Castellani M, Bacchiani G, Cali G, Mietner B, Origgi L, et al. Non-invasive assessment of pulmonary artery involvement in Takayasu's arteritis. Clin Exp Rheumatol 1999;17(2):215-8.
• 10. Churg J. Large vessel vasculitis. Clin Exp Immunol 1993;93(Suppl 1):11-2.
• 11. Yıldırım A, Işık A, Günay İ, Erdoğan E. Kalıcı körlük ile seyreden nadir bir Takayasu arteriti olgusu. Genel Tıp Derg 2007;17(1): 51-3.
• 12. Bolca O, Ünal Ş, Eren M, Dağdeviren B, Yıldırım A, Tezel T. Turkish J Thorac and Car-diovasc Surg 2000;8(3):731-3.
• 13. Campbell JD, Takach TJ, Cooley DA. Takayasu's arteritis presenting as a mediastinal mass. Tex Heart Inst J 1997;24(3):218-20.
• 14. Arend WP, Michel BA, Bloch DA, Hunder GG, Calabrese LH, Edworthy SM, et al The American College of Rheumatology 1990 criteria for the classification of Takayasu arteritis. Arthritis Rheum 1990;33(8):1129-34.
• 15. Yamada I, Nakagawa T, Himeno Y, Numano F, Shibuya H. Takayasu’s arteritis Evaluation of the thoracic aorta with CT angiography. Radiology 1998;209(1):103-9.
• 16. Hoffman GS, Leavitt RY, Kerr GS Rottem M, Sneller MC, Fauci AS. Treatment )f glucocorticoid-resistant or relapsing Takayisu arteritis with methotrexate. Arthritis Rheum 1994; 37(4):578-82.
• 17. Liang P, Hoffman GS. Advances n the medical and surgical treatment of T&ayasu Arteritis. Curr Opin Rheumatol IOO5;17(1): 16-24.
• 18. Shelhamer JH, Volkman DJ, Parrilo JE, Lawley TJ, Johnston MR, Fauci AS. Takayasu's arteritis and its therapy. Ann ntern Med 1985;103(1):121-6.