An echocardiographic finding leading to the diagnosis of giant cell arteritis.

et al. Prediction of cardiovascular outcomes with left atrial size: is volume superior to area or diameter? et al. Enlarged left atrial volume in hypertrophic cardiomyopathy: a marker for disease severity. Impairment of left atrial function predicts post-operative atrial fibrillation after coronary artery bypass graft surgery. Strain rate imaging for noninvasive functional quantification of the left atrium: comparative studies in controls and patients with atrial fibrillation. rate imaging for noninvasive functional quantification of the left atrium in hypertensive patients with paroxysmal atrial fibrillation. S et al. Strain rate imaging for functional quantification of the left atrium: atrial deformation predicts the maintenance of sinus rhythm after catheter ablation of atrial fibrillation. Effects of amiodarone on the P-wave triggered signal-averaged electrocardiogram in patients with paroxysmal atrial fibrillation and coronary artery disease. Segmental atrial contraction in patients restored to sinus rhythm after cardioversion for chronic atrial fibrillation: a colour Doppler tissue imaging study. Assessment of atrial regional and global electromechanical function by tissue velocity echocardi-ography: a feasibility study on healthy individuals. A 68-year-old patient with a history of unexplained fatigue, weight loss, and episodes of low-grade fever for several months was referred to our hospital for high-grade fever, malaise, and presyncope. There were no clear clinical foci of infection. Laboratory results showed an elevated sedimentation rate (119 mm/h) and C-reactive protein level (32 mg/L). A transoesophageal echocardiography excluded endocarditis, but detected a distinctive circumferen-tial thickening of the descending aorta, with a clear intramural hypoechogenic halo (Panel A). The ascending aorta and aortic valve showed no abnormality. Although temporal artery biopsies in the referring hospital showed no signs of giant cell arter-itis (GCA), in the clinical setting of protracted unexplained fever, weight loss, and fatigue, we judged this image compatible with GCA. Whole-body positron emission tomography (PET) confirmed a distinct image of vasculitis in the thoracic and upper abdominal aorta, expanding to the subclavian and carotid arteries (Panel B). Whole-body contrast-enhanced computed tomography scan showed slight thickening of the aortic wall (Panel C). PET/CT correlation images showed a clear focus of inflammation in the descending aorta (Panel D), which was detected earlier with transoesophageal echocardiography. The patient was diagnosed with GCA and was treated successfully with methylprednisone and methotrexate. At 2-month follow up, a positive clinical response and a reduction of inflammatory parameters were noted. The presence of a hypoechogenic halo around the lumen of temporal arteries 'halo sign' is a common finding in …