Abstract: TH-PO0051
Takayasu Arteritis Masquerading as Flash Pulmonary Edema: A Diagnostic Challenge in a Young Hypertensive Man
Session Information
- AKI: Pathogenesis and Disease Mechanisms
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Ghimire, Kalpana, St Barnabas Hospital, New York, New York, United States
- Poudel, Sajana, John H Stroger Jr Hospital of Cook County, Chicago, Illinois, United States
- Ghimire, Manoj, St Barnabas Hospital, New York, New York, United States
- Abdurham, Ahmed, St Barnabas Hospital, New York, New York, United States
- Ali, Mahmoud, St Barnabas Hospital, New York, New York, United States
Introduction
Takayasu arteritis (TA) is a chronic, large-vessel vasculitis that predominantly affects the aorta and its branches. Though renal artery involvement is common, progression to endstage renal disease requiring dialysis with pulmonary edema is rare. Diagnosing TA can be particularly challenging due to its variable presentation and overlap with other vascular disorders.
Case Description
A 32-year male presented with chest pain, pink frothy sputum, and dyspnea. He was found to be in hypertensive crisis with a creatinine level of 9.2 mg/dL and diffuse pulmonary infiltrates, consistent with flash pulmonary edema. Despite aggressive antihypertensive therapy, he developed worsening AKI requiring hemodialysis. There were no pulse deficits or vascular bruits, and initial imaging revealed no obvious renal artery stenosis. CTA abdomen revealed segmental narrowing of the abdominal aorta, an irregular suprarenal aortic aneurysm, and asymmetry in renal artery caliber, raising suspicion for large-vessel vasculitis. Infective aortitis was ruled out; serologies for HIV, syphilis, and tuberculosis were negative. Diagnosis of Takayasu arteritis was made based on clinical findings and imaging. Immunosuppressive therapy with corticosteroids and methotrexate led to a decline in inflammatory markers and clinical stabilization.
Discussion
TA is a chronic granulomatous vasculitis of large vessels mediated by cytotoxic gamma delta T cells and mast cells leading to arterial walls thickening, stenosis, and aneurysm formation. Hypertension, the most common manifestation, results from renal artery involvement or aortic narrowing. Our patient had segmental narrowing of the abdominal aorta and asymmetry in renal artery caliber, leading to renal hypoperfusion. Diagnosis was confirmed by imaging and clinical context, and the patient improved with steroids and methotrexate. This case underscores the need for clinical suspicion of TA in young patients with unexplained hypertensive crises and renal failure.