P ain of aortic origin does not necessa- rily signify an aortic emergency, even in the presence of imaging findings suggestive of an acute aortic process. In this report, we describe the case of a young fe- male patient who underwent emergency aortic surgery because of acute chest pain and imaging findings consistent with an intramural hematoma of the ascending aor- ta. However, histopathology demonstrated prominent inflammation of the aortic wall consistent with Takayasu’s arteritis. Case presentation A 36-year-old Caucasian female was re- ferred to our hospital for new-onset, inter- mittent chest pain and a discrete, hypo- dense region in the wall of the ascending aorta on an outside chest computed tomog- raphy (CT); this finding raised the question of acute aortic syndrome. The patient de- scribed multiple distinct episodes of severe central chest pain radiating to the back over the last week; she also reported sev- eral episodes of profuse sweating and near syncope over the previous months. Her medical history featured essential throm- bocytosis diagnosed 10 years before, cur- rently treated with aspirin and hydroxyurea. The physical examination was unremark- able. She was in normal sinus rhythm with- out signs of ischemia or other ECG abnor- malities. A routine laboratory workup was unremarkable apart from a platelet count of 876,000 /Ìl. Transesophageal echocardio- graphy (TEE) was performed in order to clarify the CT findings. The aorta measured normal in size at all levels. However, both long- and short-axis views of the aorta de- monstrated localized thickening of the aor- ta with a thrombus-like appearance charac- terized by echolucent areas. These features were suggestive of a crescentic intramural hematoma of the distal ascending aorta and the transverse arch (Figure 1, A & B). 280 ñ HJC (Hellenic Journal of Cardiology) Takayasu’s Arteritis Mimicking Aortic Intramural Hematoma in a Female Patient with Chest Pain ANTONIOS HALAPAS 1 , ANDREAS P. KALOGEROPOULOS 1 , VASILIKI V. GEORGIOPOULOU 1 , EDWARD P. CHEN 2 , MICHAEL B. GRAVANIS 3 , RANDOLPH P. MARTIN 1 , STAMATIOS LERAKIS 1 1 Division of Cardiology, 2 Division of Cardiothoracic Surgery, 3 Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA We report the case of a young female patient who presented with chest pain, having a background of sys- temic complaints and a history of essential thrombocytosis. Transesophageal echocardiography (TEE) was suggestive of an intramural hematoma of the distal ascending aorta and transverse arch, confirming comput- ed tomography findings. However, surgery revealed only diffuse aortic wall thickening without hematoma or dissection, despite an epiaortic ultrasonogram corroborating the TEE findings. Histopathology demonstrated inflammation involving all layers of the aortic wall, with intimal fibrosis, disrupted elastic fibers in the media, and marked fibrous thickening of the adventitia with multiple necrobiotic foci; the latter were apparently the cause of the markedly hypodense region mimicking intramural hematoma on imaging. The findings were consistent with Takayasu’s arteritis, a large vessel vasculitis of unknown etiology that predominantly affects females. Manuscript received: January 22, 2008; Accepted: June 4, 2008. Address: Andreas P. Kalogeropoulos Emory University Hospital Noninvasive Cardiology 1364 Clifton Road NE, Suite D433 Atlanta, GA 30322, USA e-mail: a_kalogero @ bellsouth.net, akaloge@emory.edu Key words: Takayasu’s arteritis, chest pain, transesophageal echocardiography, aortic diseases. Hellenic J Cardiol 2008; 49: 280-283 Case Report Case Report