Association between pericardial effusion and aortic dissection in a patient with endothelial damage and permeability caused by Takayasu arteritis: a case report

Abstract

Abstract Background Patients with Takayasu arteritis (TA) can present with aortic dissection (AD). Pericardial effusion is extremely rare in TA, and the association between pericardial effusion and progression to AD is unclear. Case presentation: We present a 51-year-old male patient who had a previous history of ulcerative colitis 20 years ago and who was treated with steroids and immunosuppressants. His fever and inflammatory reaction worsened without gastrointestinal symptoms. Based on his fluorodeoxyglucose-positron emission tomography and computed tomography scan results and clinical symptoms, he was diagnosed with TA. Eight days before surgery, the patient developed complete atrioventricular block, and a pacemaker was placed. Coronary artery computed tomography scan was performed to closely examine the coronary arteries. Ascending AD was discovered incidentally, and ascending aortic replacement was performed. Conclusions Some patients with TA exhibited high levels of vascular endothelial growth factor (VEGF), which was produced as a result of endothelial damage associated with disease activity. Patients showed high disease activity soon after the diagnosis of TA. VEGF increases vascular permeability and can cause pericardial effusion, similar to AD pathogenesis. As intimal rupture is one of the initial events of AD, changes in the intimal structure result in endothelial cell dysfunction, thereby increasing vascular endothelial permeability, which is a mechanism of pericardial effusion in AD. Pericardial effusion in AD is an ominous clinical predictor of poor outcomes and is the leading cause of mortality. Because TA with pericardial effusion may have a similar pathogenesis and vascular condition in AD, caution should be exercised when pericardial effusion is noted in patients with TA, which could be a sign of high vascular activity that possibly progresses to AD, especially immediately after diagnosis. Hence, cautious follow-up via computed tomography may be useful.