Abstract
Giant cell arteritis (GCA) is a disease of unknown origin affecting patients over 50 years of age. It presents with the inflammation of the medium and large arteritis. While there are few reports of this disease in Japan, its association with thoracic aortic aneurysms and aortic dissections has been reported. Here we present a case of GCA that was diagnosed from histological findings after surgery for acute type A aortic dissection. The patient was a 65-year-old man who underwent total arch replacement for an acute type A aortic dissection. Postoperatively, he developed systemic inflammation and a mild protracted fever. We administered antibiotics and conducted careful follow-up observations. On the 10th postoperative day, histological findings revealed infiltration of many multinucleated giant cells from the ascending aorta to aortic arch involving brachiocephalic artery, and made a diagnosis of GCA. The inflammation gradually improved with the administration of steroids. A postoperative computed tomography (CT) scan confirmed a dissecting aneurysm of the anastomosis of the brachiocephalic artery with narrowing of the true lumen. There were no symptoms and the patient was in the acute stage of dissection, we implemented the wait-and-see approach. A CT scan obtained six months later revealed expansion of the anastomotic aneurysm with severe stenosis of the true lumen. Hence, we inserted a stent graft from the right common carotid artery and achieved a favorable result.
