Kyoto Prefectural University of Medicine, Department of Cardiology, Kyoto, Japan.
J Cardiol. 2009 Aug;54(1):148-52. doi: 10.1016/j.jjcc.2008.10.007. Epub 2008 Dec 16.
A 49-year-old woman presenting with leg edema and progressive dyspnea on exertion was found to have a diastolic murmur. Echocardiography revealed increased left ventricular volume and severe aortic regurgitation (AR). She also had pain in her chest and left shoulder. Gallium scintigraphy showed increased uptake in the sternum, and further examination indicated chronic osteomyelitis in the sternum and the proximal portion of bilateral clavicles. Aortic valve replacement was performed and the ascending aorta was found to have inflammatory wall thickening with adhesion formation. Histological study and other postoperative examinations revealed Takayasu's arteritis (TA). Involvement of bone is rarely described in TA, and typical manifestations such as claudication of extremities, decreased brachial artery pulse, and arteriogram abnormality were absent, which made the preoperative diagnosis difficult. Here we report a case of severe AR due to TA which presented much difficulty in the diagnosing process, because a rare complicated illness, osteomyelitis was clinically apparent and there were few clinical manifestations related to TA.
一位 49 岁女性因腿部水肿和进行性劳力性呼吸困难就诊，发现有舒张期杂音。超声心动图显示左心室容积增加和严重主动脉瓣反流（AR）。她还感到胸痛和左肩痛。镓闪烁显像显示胸骨摄取增加，进一步检查显示胸骨和双侧锁骨近端慢性骨髓炎。进行了主动脉瓣置换术，发现升主动脉有炎症性壁增厚和粘连形成。组织学研究和其他术后检查显示为 Takayasu 动脉炎（TA）。TA 很少累及骨骼，并且没有典型的临床表现，如四肢跛行、肱动脉脉搏减弱和血管造影异常，这使得术前诊断困难。我们在此报告一例因 TA 导致的严重 AR 病例，该病例在诊断过程中遇到了很大的困难，因为一种罕见的复杂疾病——骨髓炎在临床上表现明显，而与 TA 相关的临床表现较少。
