A young female presents with diminished pulses in the upper limb and hypeension. The most likely diagnosis is:
Answer is A (Takayasu Aeritis): Diminished pulses in upper extremities and hypeension in a young female suggests a diagnosis of Takayasu aeritis. Coarctation is associated with diminished pulses in the lower extremities and Hypeension. Takayasu aeritis is typically prevalent in adolescent girls and young women (Obstruction at the level of proximal branches of the aoic arch (Subclan and Common Carotids) leads to diminished pulses in the upper extremity (Reversed Coarctation). Hypeension is a major complication of the disease and most commonly arises from renal aery stenosis. Since upper limb pulses are typically difficult to feel it may be dcult to record the blood pressure and hypeension may be easily missed. High blood pressure may be recorded in the lower limbs. 1990 criteria of American College of Rheumatology for the classification of Takayasu aeritis Criteria Definition Age at disease onset in year Development of symptoms or findings related to Takayasu aeritis at age Claudication of extremities Development and worsening of fatigue and discomfo in muscles of one or more extremity while in use, especially the upper extremities. Decreased brachial aery pulse Decreased pulsation of one or both brachial aeries BP difference >10mmHg Difference of >10mmHg in systolic blood pressure between arms Bruit over subclan aeries or aoa Bruit audible on auscultation over one or both subclan aeries or abdominal aoa Aeriogram abnormality Aeriographic narrowing or occlusion of the entire aoa, its primary branches, or large aeries in the proximal upper or lower extremities, not due aeriosclerosis, fibro-muscular dysplasia, or similar causes: changes usually focal or segmental Takayasu aeritis is diagnosed if at least three of six criteria are present.
Takayasu Aeritis
Coarctation of Aoa
Giant Cell Aeritis
Polyaeritis Nodosa