Snapshot quiz 17/1
Authors: Patel V, Thapar A, Abidia A and Farrow S
CT–PET at the level of the L1 lumbar vertebra showed large vessel vasculitis with panaortic enhancement (arrows). The 85-year-old man had a 5-day history of back and central abdominal pain. Examination elicited central abdominal tenderness. He had a white cell count of 14.8 × 109/l, neutrophil count of 10.3 × 109/l, platelet count of 149 × 109/l and C-reactive protein level of 256 mg/l. Preceding CT of the kidneys, ureters and bladder showed periaortic fat stranding with a 42-mm aortic diameter. He was referred to rheumatology who requested CT–PET. The antineutrophil cytoplasmic antibody test was positive, serology was negative for hepatitis B, hepatitis C, syphilis, antinuclear anitbody and complement components C3 and C4, and the erythrocyte sedimentation rate was normal. The
patient was commenced on corticosterids, with significant improvement and complete resolution of symptoms.