A 48 year old Irish Caucasian female presented to our Emergency department with a history of central chest pain radiating to her back in an interscapular region. The pain was of sudden onset, with the chest pain resolving spontaneously but the back pain remaining. Of note the pain was associated with shortness of breath, nausea and sweating. Her background history included being a current chronic smoker (30 pack year history), epilepsy (since 16 years old), hypercholesterolemia, depression (post partners death from ischemic heart disease 18 months previous) and a strong family history of cardiac disease. Mediactions at presentation included: Dalamne 30 mg nocté, Efexor XL 150 mg PO BD and Tegretol 200 mg PO BD. On examination she was noted to have a systolic blood pressure differential of 50 mmHg between her right and left upper limbs and had a weak radial pulse on the left side. The remainder of her examination was normal. All Cardiac bloods were within normal range. A CT thorax and abdomen were carried out to investigate the principle differential diagnosis of a dissecting aortic aneurysm. This was ruled out and a stenosis in the left subclavian artery was noted. No bruit was audible over the subclavian artery. A differential diagnosis of TA recorded. Coronary angiography, MRI angiography, along with angiography of the great vessels/aorta were carried out and these confirmed the diagnosis of TA. The coronary angiogram showed an occluded PV branch of the left circumflex artery. The ateriogram showed a long segmental left subclavian artery stenosis and a significant stenosis in the origin of the celiac artery Figure. A treatment regime of intravenous Methylprednisolone 1 g OD for three days followed by Prednisolone 60 mg PO OD for four weeks was commenced, along with Mycophenolate Mofetil 500 mg PO BD, Aspirin 75 mg PO OD, Clopidogrel 75 mg PO OD, Atorvastatin 20 mg nocté, nicotine replacement patch 14 mg TD OD and Fosavance 70 mg once weekly. These were well tolerated with no side effects experienced. She was discharged, asymptomatic, 14 days post presentation, with an outpatients follow-up for four weeks. Advice regards cessation of smoking was given and adhered to, along with diet and lifestyle improvements. At her return outpatients appointment the Mycophenolate Mofetil was increased to 750 mg PO BD. The prednisolone was changed to 30 mg PO OD for two weeks followed by 25 mg × 1/52, 20 mg × 4/52, 10 mg × 4/52, 5 mg × 3/12 and then stopped. It has been 10 months since this lady presented and currently she remains very well from a TA and cardiology viewpoint, however unfortunately she has since developed carcinoma of a gynaecological nature, cervical cancer. The cervical cancer diagnosis was confirmed two months after the diagnosis of TA. Regular follow-ups continue at increasing intervals from a TA perspective and she has been treated, successfully, for the malignancy.