We discussed a case of a young woman with chronic, progressive, R shoulder and arm pain that worsens with activity and improves with rest. R radial pulse was difficult to feel and BP in RUE was lower than BP in LUE by >20mmHgb (SBP). Patient’s CTA showed thickening of aortic arch and great vessel branches with elevation of ESR. We discussed the differential for aortic pathology.

Unilateral weakness was attributed to vascular etiology (due to claudiatication symptoms, pulselessness and BP differential) and inflammatory etiology (given high ESR). Patient was diagnosed with Takayasu Arteritis, a type of granulomatous vasculitis affecting aorta and major branches such as coronary and pulmonary arteries. Patient improved on steroids and rituximab with follow up CTA showing normal aorta.