Correct!
6. 1 and 4

The ultrasound shows a thoracic aortic aneurysm and aortic wall thickening. The markedly elevated sedimentation rate in the setting of an aneurysm or vasculitis suggests giant cell arteritis, and corticosteroids should be started as soon as giant cell arteritis is suspected to prevent blindness (1). However, vascular wall thickening at imaging is not specific for arteritis and can be caused by acute aortic syndromes, such as intramural hematoma or thrombosis of the false lumen of an aortic dissection (2). Such abnormalities are urgent findings and may be difficult to distinguish from vasculitis on ultrasound, and should be evaluated with thoracic CT or MR. The wall thickening proved to be an intramural hematoma on thoracic CT scan.  Unfortunately, the patient had further dissection of her aneurysm and was referred to hospice.

Michael B. Gotway, MD
Department of Radiology
Mayo Clinic Arizona

References

  1. Waldman CW, Waldman SD, Waldman RA. Giant cell arteritis. Med Clin North Am. 2013;97(2):329-35. [CrossRef] [PubMed] 
  2. Pandit A, Panse PM, Gruden JF, Gotway MB. Pulmonary artery sheath haematoma with pulmonary arterial compression: a rare complication of type A aortic dissection mistaken for aortitis. Eur Heart J. 2013 Jun 20 [Epub ahead of print] [CrossRef] [PubMed]

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