Vasculitis was identified in a 28 year-old female with unrelenting back pain initially referred for MR examination to rule out aortic dissection; additional history revealed recent unintentional 5 kg weight loss . A. Contrast-enhanced magnetic resonance angiography (CE-MRA) showed diffuse luminal irregularities (arrows). B. Pre-contrast dark blood imaging indicated marked aortic wall thickening to 9–10 mm (arrowheads). There was marked elevation of inflammatory markers including erythrocyte sedimentation rate (ESR, 94 mm/hr) and c-reactive protein (7.3 mg/L) levels. Symptoms markedly improved with prednisone, with reduced ESR (12 mm/hr) and aortic wall thickness at 12-month follow-up.