array:24 [ "pii" => "S2173510724000995" "issn" => "21735107" "doi" => "10.1016/j.rxeng.2023.11.009" "estado" => "S300" "fechaPublicacion" => "2024-09-01" "aid" => "1551" "copyright" => "SERAM" "copyrightAnyo" => "2023" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Radiologia. 2024;66:485-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0033833823002151" "issn" => "00338338" "doi" => "10.1016/j.rx.2023.11.007" "estado" => "S300" "fechaPublicacion" => "2024-09-01" "aid" => "1551" "copyright" => "SERAM" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Radiologia. 2024;66:485-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científica</span>" "titulo" => "Afectación de los troncos supraaórticos en la arteritis de Takayasu" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "485" "paginaFinal" => "486" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Involvement of supra-aortic trunks in Takayasu arteritis" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 864 "Ancho" => 1905 "Tamanyo" => 201226 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hallazgos en imagen. La ecografía inicial muestra un engrosamiento concéntrico de los segmentos proximales de la pared arterial de la CC izquierda (flechas blancas en A). La imagen axial de ATC demuestra un engrosamiento concéntrico de las paredes de los troncos supraaórticos (flechas azules en B). La ATC axial, la reconstrucción de volumen 3D y la ATC coronal resaltan una estenosis del lumen del 50% en la CC izquierda (círculos amarillos en C, D y E, respectivamente). La PET/TC muestra un aumento sutil de la captación de FDG en toda la CC izquierda (círculo amarillo en F).</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">ATC: angiografía por tomografía computarizada; CC: carótida común; FDG: 18F-Fluorodesoxiglucosa; PET/TC: tomografía por emisión de positrones.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F.D. Choque-Chávez, A. Jareño-Badenas" "autores" => array:2 [ 0 => array:2 [ "nombre" => "F.D." 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A) Sagittal CT image of the neck after contrast administration: a retropharyngeal collection without peripheral enhancement is observed (red arrow), as well as a small calcification anterior to the odontoid process (yellow arrow). B) Sagittal T2-weighted MR image: the collection with high signal intensity can be seen (red arrow), while the calcification is a very hypointense lesion (yellow arrow). C) Axial T2-weighted MR image: prevertebral calcification (yellow arrow) anterior to the odontoid is identified, which is associated with inflammatory changes in the adjacent tissues (the green arrow indicates oedema of the left longus capitis muscle). D) Plain X-ray of the cervical spine of another female patient: a calcification is observed anterior to the odontoid process, in the same location as in the female patient in case 2.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Durán Lojo, J. Martel Villagrán" "autores" => array:2 [ 0 => array:2 [ "nombre" => "S." 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"apellidos" => "Martel Villagrán" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510724001009?idApp=UINPBA00004N" "url" => "/21735107/0000006600000005/v1_202410180614/S2173510724001009/v1_202410180614/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173510724000983" "issn" => "21735107" "doi" => "10.1016/j.rxeng.2023.03.008" "estado" => "S300" "fechaPublicacion" => "2024-09-01" "aid" => "1496" "copyright" => "SERAM" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Radiologia. 2024;66:479-84" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Brief report</span>" "titulo" => "Myofibroblastoma of the breast: 3 case reports and review of literature" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "479" "paginaFinal" => "484" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Miofibroblastoma de mama: 3 casos clínicos y revisión de la literatura médica" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3673 "Ancho" => 2508 "Tamanyo" => 1085072 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) DBT shows a fat-containing 25-mm nodule with circumscribed margins. (B) Ultrasound image shows an oval hyperechoic heterogeneous nodule. (C) Macroscopically, the mastectomy revealed a firm, rubbery, yellowish, well-defined mass without infiltration into the surrounding tissue. (D) Photomicrograph (original magnification, ×40; H&E stain) shows fascicles of spindle cells interspersed with bands of hyalinised collagen. (E, F) Moderate immunoreactivity for CD10 and desmin ×20.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Sitges, B. Úbeda, S. Ganau, M. Macedo, E. Sanfeliu, X. Bargalló" "autores" => array:6 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Sitges" ] 1 => array:2 [ "nombre" => "B." "apellidos" => "Úbeda" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Ganau" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Macedo" ] 4 => array:2 [ "nombre" => "E." "apellidos" => "Sanfeliu" ] 5 => array:2 [ "nombre" => "X." "apellidos" => "Bargalló" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0033833823000929" "doi" => "10.1016/j.rx.2023.03.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0033833823000929?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510724000983?idApp=UINPBA00004N" "url" => "/21735107/0000006600000005/v1_202410180614/S2173510724000983/v1_202410180614/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Involvement of supra-aortic trunks in Takayasu arteritis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "485" "paginaFinal" => "486" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "F.D. Choque-Chávez, A. Jareño-Badenas" "autores" => array:2 [ 0 => array:4 [ "nombre" => "F.D." "apellidos" => "Choque-Chávez" "email" => array:1 [ 0 => "diegochoquechavez@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Jareño-Badenas" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento de Radiología, Hospital Clínic de Barcelona, Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Afectación de los troncos supraaórticos en la arteritis de Takayasu" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 864 "Ancho" => 1905 "Tamanyo" => 201226 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Imaging findings. Initial echography shows concentric thickening of the proximal segments of the arterial wall of the left CC (white arrows in A). Axial CTA image reveals concentric thickening of the walls of the supra-aortic trunks (blue arrows in B). Axial CTA, 3D volume reconstruction and coronal CTA highlight 50% luminal stenosis in the left CC (yellow circles in C, D and E, respectively). The PET/CT shows a subtle increase in FDG uptake throughout the left CC (yellow circle in F).</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">CTA: computerised tomography angiography; CC: common carotid; FDG: 18F-Fluorodeoxyglucose; PET/CT: Positron emission tomography.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In current medical practice, computerised tomography (CT) protocols for stroke, including computerised tomography angiogram (CTA), are increasingly used along with other body imaging studies.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In this context, radiologists must remember that certain imaging features and radiological signs can delimit the differential diagnosis in specific clinical scenarios. The objective of this scientific letter is to describe the imaging features that help guide the diagnosis towards Takayasu’s arteritis (TA) in a specific clinical scenario.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 22-year-old man attended the outpatient clinic complaining of left cervical pain for a week. The subject had no significant medical history or recent trauma. Initially, the clinical impression pointed to a possible injury to the left sternocleidomastoid muscle, so treatment with anti-inflammatory drugs was initiated. However, the subject returned to the clinic three months later due to persistent left neck pain, so a cervical echography was requested.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Echography revealed a thickening of the arterial wall in the proximal segment of the left common carotid (CC) corresponding to the pain site (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A), indicating carotidynia. Following the echography findings, a CTA was performed. The CTA revealed concentric thickening of the supra-aortic trunks (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). The most significant involvement was observed in the left CC, where 50% luminal stenosis was identified (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C–E). Body CTA showed no involvement of other vascular territories (images not shown). Laboratory studies revealed a slight elevation of C-reactive protein (CRP) levels (3.6 mg/dl), while the erythrocyte sedimentation rate (ESR) value was within the normal range (12 mm/h). A positron emission tomogram (PET-CT) was also performed, which revealed increased tracer uptake in the left CC (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>F).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">In this context, and taking into account the subject’s age, the most likely diagnosis was TA. TA is large vessel vasculitis that mainly affects the aorta and its primary branches.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The onset of TA symptoms is subacute. Its clinical presentation includes constitutional symptoms, arthralgia, carotidynia, claudication of the extremities, arterial bruit, blood pressure discrepancy between the arms, angina pectoris or ischaemic cardiac pain. In most cases, diagnosis is based on clinical and imaging features, as in this case.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The main differential diagnosis is giant cell arteritis (GCA). However, TA differs from GCA in several significant ways. Firstly, the age of onset of TA is usually between 10 and 40 years, while GCA predominantly affects patients over 50 years of age. Regarding imaging tests, TA mainly affects the aorta and its branches, while GCA commonly affects the branches of the external carotid artery. Disease progression also differs between the two conditions. GCA usually follows a self-limiting course, while TA tends to manifest as a chronic condition.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5</span></a> Other possible diagnoses include atherosclerosis, infectious aortitis, Behcet syndrome, IgG4-related disease and fibromuscular dysplasia. However, their probability was reduced by clinical scenario, imaging features and patient age.</p><p id="par0025" class="elsevierStylePara elsevierViewall">This case illustrates the importance that radiology can have in the diagnostic process, especially in complex cases. This subject, who presented nonspecific cervical pain, was diagnosed with carotidynia after an evaluation by echography. Evaluation of the arterial vasculature by CTA and PET-CT revealed concentric thickening of the supra-aortic trunks without evidence of involvement of other arterial vessels. Taken together, the results clearly pointed to TA. The differential diagnoses mentioned above were much less likely on both clinical and radiological grounds.</p><p id="par0030" class="elsevierStylePara elsevierViewall">To conclude, this scientific letter provides a clear example of how a thickened wall of the supra-aortic trunks can be a clarifying feature in young patients with TA. It is imperative to keep this in mind, given the widespread use of CT in diagnostic imaging studies.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">There are no conflicts of interest to report.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:2 [ "identificador" => "xack782624" "titulo" => "Acknowledgements" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 864 "Ancho" => 1905 "Tamanyo" => 201226 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Imaging findings. Initial echography shows concentric thickening of the proximal segments of the arterial wall of the left CC (white arrows in A). Axial CTA image reveals concentric thickening of the walls of the supra-aortic trunks (blue arrows in B). Axial CTA, 3D volume reconstruction and coronal CTA highlight 50% luminal stenosis in the left CC (yellow circles in C, D and E, respectively). The PET/CT shows a subtle increase in FDG uptake throughout the left CC (yellow circle in F).</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">CTA: computerised tomography angiography; CC: common carotid; FDG: 18F-Fluorodeoxyglucose; PET/CT: Positron emission tomography.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of diagnostic imaging studies and associated radiation exposure for patients enrolled in large integrated health care systems, 1996-2010" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Smith-Bindman" 1 => "D.L. Miglioretti" 2 => "E. Johnson" 3 => "C. Lee" 4 => "H.S. Feigelson" 5 => "M. Flynn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2012.5960" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2012" "volumen" => "307" "paginaInicial" => "2400" "paginaFinal" => "2409" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22692172" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2022 American College of Rheumatology/EULAR Classification Criteria for Takayasu Arteritis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.C. Grayson" 1 => "C. Ponte" 2 => "R. Suppiah" 3 => "J.C. Robson" 4 => "K.B. Gribbons" 5 => "A. Judge" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arthritis Rheumatol Hoboken NJ" "fecha" => "2022" "volumen" => "74" "paginaInicial" => "1872" "paginaFinal" => "1880" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Giant Cell Arteritis versus Takayasu Arteritis: an update" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P. Stamatis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.31138/mjr.31.2.174" "Revista" => array:7 [ "tituloSerie" => "Mediterr J Rheumatol" "fecha" => "2020" "volumen" => "31" "paginaInicial" => "174" "paginaFinal" => "182" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32676554" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0012369219301436" "estado" => "S300" "issn" => "00123692" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Takayasu arteritis: imaging spectrum at multidetector CT angiography" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "F.P. Zhu" 1 => "S. Luo" 2 => "Z.J. Wang" 3 => "Z.Y. Jin" 4 => "L.J. Zhang" 5 => "G.M. Lu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1259/bjr/25536451" "Revista" => array:6 [ "tituloSerie" => "Br J Radiol" "fecha" => "2012" "volumen" => "85" "paginaInicial" => "e1282" "paginaFinal" => "92" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23175494" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Large vessel vasculitis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Pugh" 1 => "M. Karabayas" 2 => "N. Basu" 3 => "M.C. Cid" 4 => "R. Goel" 5 => "C.S. Goodyear" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Nat Rev Dis Primer" "fecha" => "2022" "volumen" => "7" "paginaInicial" => "93" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack782624" "titulo" => "Acknowledgements" "texto" => "<p id="par0040" class="elsevierStylePara elsevierViewall">We would like to thank Dr. Antonio López Rueda for sharing the imaging studies, for his help and for his feedback that greatly improved the manuscript.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/21735107/0000006600000005/v1_202410180614/S2173510724000995/v1_202410180614/en/main.assets" "Apartado" => array:4 [ "identificador" => "77332" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letter" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735107/0000006600000005/v1_202410180614/S2173510724000995/v1_202410180614/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510724000995?idApp=UINPBA00004N" ]
Journal Information
Vol. 66. Issue 5.
Pages 485-486 (September - October 2024)
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Vol. 66. Issue 5.
Pages 485-486 (September - October 2024)
Scientific letter
Involvement of supra-aortic trunks in Takayasu arteritis
Afectación de los troncos supraaórticos en la arteritis de Takayasu
F.D. Choque-Chávez
, A. Jareño-Badenas
Corresponding author
Departamento de Radiología, Hospital Clínic de Barcelona, Barcelona, Spain
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