Transesophageal echocardiography is suitable for evaluating the stage of takayasu arteritis with aortic aneurysm

Abstract

Takayasu arteritis (TA) is occasionally complicated with aneurysm formation. Imaging modalities, such as CT and MRI, can detect aortic wall inflammatory lesions but not the stage of inflammation. Here we evaluated the usefulness of transesophageal echo (TEE) for detection of TA inflammatory lesions and their stages. Aortae were obtained from 9 autopsies of patients with TA. Specimens were evaluated while in degassing water. The distance between the specimen and TEE transducer (5.0-MHz, electric sector scanning) was constant for all specimens. The echo gain was set at 52, which visualized delineation of the normal left ventricle in degassing water. The areas observed by ultrasonography were then examined histopathologically. Eight atherosclerotic aneurysms with/without mural thrombi and 7 normal aortae were included as control samples and processed in a similar fashion. TA showed two patterns: 2 showed intima-media thickening (IMT) and dense echogenic layers outside of IMT, corresponding to the acute stage of TA, and 7 showed a single thickened echogenic homogeneous layer, corresponding to the scar stage of TA. Atherosclerotic aneurysms included 6 samples with mural thrombi and their image were echogenic and showed heterogeneous thin layers, while 2 samples had no mural thrombi and the images showed thickened inner echogenic layer combined with localized sonolucent area. Normal control aortae showed IMT. TEE is a suitable imaging modality for determining the pathology of aneurysm and stage of inflammation in Takayasu arteritis.