Vanishing Abdominal Aorta

Fewer than 1% of Takayasu arteritis (TA) cases are diagnosed in individuals over 60 years old.¹ Early-stage TA generally presents with nonspecific systemic inflammatory symptoms, which can progress to the chronic, fibrotic occlusive phase,² although there is significant heterogeneity in disease activity.³ Additionally, 10% to 20% of patients are clinically asymptomatic and incidentally diagnosed.⁴

A 60-year-old woman presented to the emergency room (ER) with fever and abdominal discomfort, and was found to have pyelonephritis with bacteremia. Enhanced computed tomography (CT) of the abdomen obtained from the ER revealed a nonenhancing lesion extending from the abdominal aorta below the branch of the renal artery to the bilateral common iliac arteries. She had never experienced ischemic symptoms. She had no specific medical history, never smoked, rarely drank alcohol, and had no history of diabetes or hypertension. However, she noted blood pressure in her right arm had been lower than that in her left arm since long ago, although it was asymptomatic. Electrocardiography, echocardiography, and coronary CT findings were unremarkable, and it was concluded atherosclerosis was unlikely to be the primary cause of arterial occlusion. Additional enhanced chest CT showed stenosis in the right subclavian artery. She was referred to the rheumatology department and was diagnosed with TA. Over 2 years later, a 3-D CT showed no significant new stenosis and confirmed the presence of established collateral circulation (Figure 1). She remained asymptomatic and no treatment was required.

• Download figure
• Open in new tab
• Download powerpoint

Figure 1.

(A) Coronal view and (B) sagittal view of 3-D computed tomography scan showing Takayasu arteritis.

When vascular stenosis or occlusion is observed, TA should be considered, even in elderly patients.

• Copyright © 2025 by the Journal of Rheumatology