PMC5651111_01
Noncontrast CT of the chest demonstrated (a) ectasia of the ascending aorta, measuring 3.4 cm, and (b) focal narrowing of the descending aorta, measuring 1.7 cm, raising concern for an aortitis in the setting of glomerulonephritis. The white arrow in (a) represents the ascending thoracic aorta and in (b) the descending thoracic aorta.
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fig1
Unenhanced CT of the chest was then obtained to evaluate intrathoracic disease in the presence of renal failure and concern for vasculitis (Figure 1).
MRI/MRA through the chest, abdomen, and pelvis was obtained. (a) Axial double inversion recovery sequence through the upper chest demonstrates mural thickening of the brachiocephalic, left common carotid, and left subclavian arteries. (b) Axial double inversion recovery sequence demonstrates mural thickening of the ascending aorta which measures 3.4 cm in diameter. (c) Axial double inversion recovery sequence demonstrates a focal narrowing of the descending aorta, measuring 2.2 cm. (d) Inferior to the focal narrowing visualized in (c), the aorta measures 3.2 cm on axial double inversion recovery sequence. (e) Sagittal oblique cine-FIESTA sequence demonstrates the undulating contour of the abdominal aorta. (f) Axial T2 FIESTA fat saturated sequences through the abdomen demonstrate wall thickening and mural narrowing of the superior mesenteric artery. The white arrow represents in (b) ascending thoracic aorta; (c) and (d) descending thoracic aorta; (f) SMA.
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fig2
MRI and MRA of the abdomen and pelvis were obtained. (a) LAVA postcontrast sequence demonstrates mural thickening and marked luminal narrowing of the superior mesenteric artery. (b) Axial double inversion recovery sequence demonstrates increased focal narrowing of the descending thoracic aorta, measuring 1.6 cm in diameter. The white arrow represents in (a) SMA and in (b) descending thoracic aorta.
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fig3
Repeat MRI/MRA was obtained at this time to evaluate for worsening vasculitis and sequelae of the inflammation (Figure 3).