Unruptured sinus of valsalva aneurysm in a case of large vessel vasculitis: A diagnostic dilemma.

ABSTRACT

BACKGROUND: Takayasu arteritis and tuberculous aortitis, both can result in aneurysmal disease of the aorta. The overlapping imaging features in case of large vessel vasculitis can create a diagnostic dilemma. AIM: We present a case of large vessel vasculitis and chronic empyema with unruptured sinus of valsalva aneurysm. METHODS AND RESULTS: A 30-year-old man presented with acute onset shortness of breath, palpitations, and gradually progressing pedal edema. The echocardiography and CT angiogram revealed features of large vessel vasculitis and chronic empyema along with unruptured sinus of valsava aneurysms. Patient underwent emergency Bentall procedure and the histopathology confirmed the diagnosis of takayasu arteritis. DISCUSSION: Tuberculosis being an endemic disease with varied presentations should always be considered a differential diagnosis, whenever appropriate. An unruptured sinus of valsalva aneurysm can be clinically silent or can cause compression symptoms. Although there are no specific guidelines regarding surgical correction, symptomatic and aneurysms of size >5.5cm are usually managed surgically. CONCLUSION: Unruptured sinus of valsalva aneurysms can be seen in Takayasu arteritis, which complicates the methodology and timing of the surgical management.