Calcium sign of thoracic aortic dissection in Takayasus arteritis

Description

A 53-year-old woman with known chronic atrial fibrillation was referred for evaluation of abnormal chest film. She has been diagnosed with Takayasu's arteritis 10 years earlier when she underwent right subclavian-to-common carotid artery bypass grafting due to major aortic branches occlusion. Initial examination revealed totally irregular pulse with cardiomegaly. The blood pressure was normotensive without significant difference among all extremities.

Chest film unveiled cardiomegaly with long, diffuse calcified descending thoracic aorta (figure 1A, arrowheads). Notably, dilatation of the proximal descending thoracic aorta was suggestive of aortic aneurysm. The curvilinear calcification (figure 1A, arrow) medial to the aortic wall corresponded with the splitting of intimal calcification in CT scan (figure 1B,C: contrast-enhanced CT in coronal and axial planes, figure 1D: non contrast-enhanced CT in axial plane). The true lumen (T) was smaller and located medially to the false lumen (F). Since...

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