Which vasculitis is defined by severe luminal narrowing with granulomatous thickening of the wall, typically involving the aortic arch?

• A. Giant cell arteritis
• B. Kawasaki disease
• C. Takayasu arteritis
• D. Polyarteritis nodosa

Answer: (C)

Takayasu arteritis is a granulomatous large-vessel vasculitis that principally involves the aorta and its major branches. The inflammatory process causes granulomatous thickening of the vessel wall with intimal hyperplasia, leading to marked luminal narrowing. The aortic arch is a classic site, which explains symptoms related to reduced blood flow to the head and upper extremities and the classic “pulseless” presentation. This combination of granulomatous wall thickening and severe stenosis of the great vessels is characteristic. It typically affects young women, particularly in certain populations. Other vasculitides involve granulomatous inflammation in different contexts (for example, giant cell arteritis in older adults and Kawasaki disease in children) or affect different sized vessels with different pathologies (polyarteritis nodosa affects medium-sized arteries with necrotizing changes rather than the granulomatous arch involvement seen here).