(4) in diagnosing Takayasu arteritis consists of three major criteria, including the left and right mid-sub-clavian artery lesions and characteristic signs and symptoms lasting for at least 1 month and 10 minor criteria: a high ESR, carotid artery tenderness, hypertension, aortic regurgitation or annuloaortic ectasia, pulmonary artery lesion, left mid-common carotid lesion, distal brachiocephalic trunk
lesion, descending thoracic aorta lesion, abdominal aorta lesion, and coronary artery lesion.
They were located in the thoracic aorta (n=14, 28%), including the ascending aorta (n=2, 4%), aortic arch (n=7, 14%), descending aorta (n=5, 10%), coronary artery (n=2, 4%), pulmonary artery (n=1, 2%), left subclavian artery (n=1, 2%), left common carotid artery (n=1, 2%), brachiocephalic trunk
(n=1, 2%), aortaventralis (n=11, 22%), celiac trunk (n=5, 10%), splenic artery (n=1, 2%), iliac artery (n=9, 18%), renal artery (n=1, 2%) IMA (n=1, 2%), and SMA (n=2, 4%).
With this finding, a color Echo-Doppler of the neck vessels was requested, which revealed the absence of the brachiocephalic trunk
and the base of both carotids very close to one another, as well as the base of the right subclavian artery directly from the aortic arch to the left of the left subclavian artery (Fig.
An MRI neck showed an altered signal intensity SOL (38*41*47 mm), located in thoracic inlet extending into the retromanubrium space, abutting the trachea and the brachiocephalic trunk
with maintained fat planes (Fig.
As a preparation for the resection of the substernal goiter, the major blood vessels, including the innominate vein, brachiocephalic trunk
, superior vena cava, and left subclavian artery, were carefully separated from the substernal goiter, and then thyroidectomy was performed (Figure 3).
Arch of aorta (AOA) is the continuation of ascending aorta, and usually, it gives three branches, namely, from right to left, brachiocephalic trunk
, left common carotid artery (LCCA), and left subclavian artery (LSCA).
Normally, the typical aortic arch branching pattern (with an incidence rate from 64.9% to 94.3%) consists of three divisions: the brachiocephalic trunk
, the left common carotid artery, and the LSA.
In addition, in our case, aortic dissection extended to the brachiocephalic trunk
, closing down and occluding the ostium of the right subclavian artery.
Upon insertion of the catheter near the right brachiocephalic trunk
prior to the engagement of his left coronary artery, profound bradycardia was noted, with an HR of 25 beats/min.
The mean diameter of the aorta was determined as 9.8mm at its origin and as 6.9mm after giving off the brachiocephalic trunks
. The mean diameters of the left brachiocephalic trunk
, which arose in the first place from the ascending aorta, and the right brachiocephalic trunk
, which stemmed from the ascending aorta immediately after the origin of the left trunk, were determined to be 6.5mm and 7.3mm, respectively.
Normally the right common carotid artery branches from the brachiocephalic trunk
also known as an innominate artery, which originates from the aortic arch.
It is true that orientation of brachiocephalic trunk
is sometimes attributed to hyperextension of the head as it elevates the innominate artery and brings it against the tracheal wall at the level of tip or cuff of the tracheostomy tube, making the tracheal wall more vulnerable to ulceration.3 This may be of particular significance in the case described, as the patient was in a state of coma and appropriate neck positioning is difficult to ascertain in similar patients.