Takayasu Arteritis

This photo from a young woman who died suddenly with cardiac tamponade from an aortic dissection reveals an intimal tear following aortitis with “tree barking”, a phenomenon usually associated with syphilic aortitis but seen in other vasculitides.

A giant cell is seen in the partially necrotic wall. Giant cells are more characteristic of giant cell arteritis but are also seen in Takayasu disease.

The intima is thickened and fibrotic. There is a focus of necrosis in the media with an inflammatory deposit. Three arteritides; syphilitic, giant cell, and Takayasu are sometimes difficult to differentiate histologically. All three can show necrosis, giant cells, and perivascular cuffing.

This arteritis is most frequently seen in young women. Clinical presentations may include visual disturbances, coldness of the arms and fingers, or neurological deficits. It is sometimes referred to as 'pulseless disease' because of the effects of the marked luminal narrowing. The pulmonary arteries can be affected resulting in pulmonary hypertension.