| ObjectiveTo summarize and analyze the clinical and imaging features of middle aortic syndrome secondary to Takayasu’s arteritis and to explore the clinical value of ultrasound in diagnosis,with the purpose of improving the understanding of this syndrome by clinical and imaging doctors.MethodsReviewing 92 patients with Takayasu’s arteritis who attended the First Hospital of Jilin University from January 2018 to January 2022,there were 13 cases of middle aortic syndrome secondary to Takayasu’s arteritis.Collecting and summarizing the general data,physical examination,clinical manifestations and imaging manifestations of 13 cases,discussed and analyzed the clinical and imaging features of middle aortic syndrome secondary to Takayasu’s arteritis in combination with relevant literatures.The consistency of ultrasound and CTA in detecting vascular stenosis was tested and the clinical value of ultrasound in diagnosis is also discussed.Results（1）In this study,there were 13 patients with middle aortic syndrome secondary to Takayasu’s arteritis,including 1 male and 12 female,with an average age of 22.92 ±12.04 years;（2）Signs: All 13（100%）patients examined had weakened femoral artery pulsation on both sides;（3）Clinical manifestations: Of the 13 patients with middle aortic syndrome secondary to Takayasu’s arteritis,one patient（7.7%）was admitted because of increasing frequency of nocturia.12（92.3%）patients were admitted because of significantly elevated blood pressure.Among the 13 patients,4（30.8%）cases had hypertension in children or adolescents,and their blood pressure was higher than the99 th percentile in children of the same sex,age and height;There were 9（69.2%）cases of hypertension in adults,of which 77.8% were grade Ⅲ hypertension.Among the 13 patients,9（69.2%）cases had hypertensive target organ involvement: including 4（30.8%）cases had retinopathy,6（46.2%）cases had cardiac changes,and 3（23.1%）cases had renal insufficiency;5（38.5%）cases had associated or previous tuberculosis infection.（4）Sonographic findings: The two-dimensional gray scale ultrasound of this group of patients all showed that the hierarchy of the affected abdominal aortic wall is unclear and the segmental or diffuse thickness of the vascular wall caused luminal stenosis.The color doppler showed the blood flow filling defect and "multicolored mosaic" high-speed blood flow signal at the stenosis.The severe stenosis or almost occlusive lumen had no blood flow signal.The peak systolic speed of the stenosis in the spectrum doppler is significantly increased.When the stenosis is located below the renal artery ostia,"tardus-parvus wave" were observed only in the distal part of the affected abdominal aorta,while when the stenosis was located above the opening of the renal artery,the "tardus parvus wave" with low speed and low pulsatility could be seen in the main trunk of the renal artery as well as distal segmental arteries and interlobar arteries in addition to distal part of the affected abdominal aorta regardless of whether renal artery stenosis is present or not.Ultrasound could also observe the formation of peripheral collateral vessels around severe stenosis,but there were limitations in the overall observation of the collaterals;（5）Computed tomography angiography（CTA）manifestations: CTA observed that the wall of the affected thoracic and abdominal aorta and some of its branches were not smooth,and the vascular wall showed segmental circular and moon-shaped thickening.Multiple concentric hypodensity shadows and nodular calcification shadows were observed in the affected vessels.Some lumen were narrowed or even occluded to varying degrees,and contrast agent filling defects and intermittent imaging could also be seen.Extensive collateral vessel formation is seen around the stenosis in 8（61.5%）cases: collateral circulation of superior mesenteric artery and inferior mesenteric artery was formed in 4（30.8%）cases,bilateral subclavian artery-bilateral iliac artery collateral circulation was formed in 1（7.7%）case,collateral circulation around renal artery was formed in 1（7.7%）case,and collateral circulation around the affected abdominal aorta was formed in 2（15.4%）cases.The formation of the above collateral circulations was considered as a compensatory change for the severe stenosis of the involved vessels.（6）Among the 13 patients in this group,11（84.6%）were diagnosed by ultrasound and 13（100%）were diagnosed by CTA,among which 2 patients not detected by ultrasound were found to be involved in lower thoracic aorta after CTA examination.100 vessels were examined by ultrasound and CTA at the same time,and 34 vessels were diagnosed by ultrasound with vascular stenosis,which was later confirmed in CTA.The consistency test between ultrasound and CTA on whether there was vascular stenosis was conducted,and the Kappa value was 0.871,P value < 0.001.The results of ultrasonic detection of vascular stenosis indicated that there was a good consistency between the ultrasonic examination results and CTA to determine whether there was stenosis in blood vessels.Conclusions（1）Ultrasound and CTA have a good consistency in the examination of the vascular involved in middle aortic syndrome secondary to Takayasu’s arteritis and can be used as an auxiliary examination method.（2）Ultrasound features of middle aortic syndrome secondary to Takayasu’s arteritis are significant thickening of the wall of the affected artery which leading to luminal stenosis and corresponding hemodynamic changes.（3）CTA of middle aortic syndrome secondary to Takayasu’s arteritis is characterized by segmental circular thickening of the affected vascular wall and extensive collateral circulation around narrowed vessels.（4）Significant hypertension is mostly the first and typical clinical manifestations of middle aortic syndrome secondary to Takayasu’s arteritis,and often accompanied by the structural and functional changes of target organs secondary to hypertension.（5）The signs of middle aortic syndrome secondary to Takayasu’s arteritis is often presented with significant hypertension and decreased bilateral femoral artery pulses. |
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