Panel a shows coronal computed tomography angiogram image with brachiocephalic trunk stenosis and post-stenotic dilatation. Panel b shows coronal angiographic image with occluded proximal left subclavian artery and collateral vessels. Panel c shows coronal image demonstrating non-opacified arteries and necrotic right paratracheal lymphadenopathy. Panel d shows axial computed tomography image with aortic mural thickening, calcifications, and pleural effusion. Panel e shows volume-rendered angiographic image demonstrating extensive aneurysmal aortic dilatation and collateral circulation. Panel f shows maximum intensity projection angiographic image highlighting aneurysmal aortic dilatation and mural calcifications.
Panel of CT angiography images showing aneurysmal dilataion of aorta and its branches with development of collaterals and mediatstinal lymphadenopathy in patient 1. (a–d) Panel of CT angiogram images of patient 1: reconstructed coronal images (a and b) show focal stenosis at the origin of the right brachiocephalic trunk (solid white arrow below the arrowhead) with poststenotic dilation (arrowhead). Right common carotid (solid white arrow above the arrowhead in a) and subclavian (arrows in b) are normal. Reconstructed coronal image (c) shows nonopacified (occluded) proximal left subclavian artery until the origin of the vertebral artery (arrow). Note the left common carotid artery is also not opacified. Conglomerate necrotic lymph nodes are seen in right paratracheal location (thick arrow in c). Axial image (d) shows circumferential mural thickening of the ascending and descending thoracic aorta with mural calcifications (thin arrows). Note necrotic subcarinal lymphadenopathy (thick arrow) and right pleural effusion (asterisk). (e and f) CT angiogram volume rendered (e) and maximum-intensity projection (f) images show aneurysmal dilatation of the aorta extending from the aortic root up to the suprarenal part of the abdominal aorta (thick white arrows). Note multiple mural calcifications (thin white arrows) and multiple collaterals in the neck (red arrows). Visceral arteries including renal and iliac arteries are normal.