Malignant hypertension, dissection of aorta, cardiac tamponade and monoparesis-Unusual presentation of Takayasu's arteritis: Clinicopathological correlation

We report a case of a 24-year-old woman with an unremarkable past medical history who was presented to the emergency department with acute onset of breathlessness and weakness of right lower limb. Clinical examination was suggestive of malignant hypertension with acute left ventricular failure and acute ischemia of right lower limb. Colour Doppler and CT findings were consistent with dissection of entire aorta with extension into its major branches. She died in less than 18 h after admission following cardiac tamponade. Autopsy revealed left renal artery stenosis with features of Takayasu's arteritis with intimal rupture in the abdominal aorta with Stanford type A dissection of aorta extending to all the major branches of aorta, and hemopericardium. This case demonstrates a rare example Takayasu's arteritis involving left renal artery leading to secondary hypertension presenting as malignant hypertension with fatal dissection of aorta with cardiac tamponade and emphasizes the varied presentations of this disease and importance of early diagnosis and interventions to prevent these fatal complications.