1. Vascular (Vasculitis) Flashcards

1
Q

Vasculitis - imaging (5)

A

All types look similar.
Wall thickening,
Occlusions,
Dilatations,
Aneurysm formation

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2
Q

Vasculitis - types (4)

A

Large vessel (Takayasu, Giant cell, Cogan syndrome),
Medium vessel (PAN, Kawasaki),
Small vessel ANCA + (Wegeners, Churg strauss, Microscopic polyangiitis),
Small vessel ANCA negative (HSP, Behcets, Burgers)

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3
Q

Takayasu Arteritis - trivia (3)

A

Commonest in 15-30YO Asian women.
Asian or Involving aorta is most likely takayasu.
5 types, beyond scope of FRCR, but type 3 (involving arch and abdominal aorta) is most common.

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4
Q

Giant cell arteritis - trivia (2)

A

Commonest primary system vasculitis.
Commonest in older men (70-80).

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4
Q

Takayasu arteritis - imaging (5)

A

Acute phase:
Wall thickening and enhancement.
Occlusions of major aortic branches, or dilatation of aorta and major branches.
Aortic valve often involved (stenosis or insufficiency).
Late phase:
Diffuse narrowing distally.
Peripheral pruning of pulmonary arteries.

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5
Q

Giant cell arteritis - features (4)

A

Commonly involves aorta, major branches and particularly branches of external carotid (Temporal Artery).
ESR and CRP markedly elevated.
Rx: Responds to steroids.
Gold standard for diagnosis is temporal artery biopsy (often negative)

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6
Q

Giant cell arteritis - imaging (2)

A

US: thickening of wall of temporal artery
CT/MRA/angiogram of armpit area: Wall thickening, occlusions, dilatation, aneurysms.

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7
Q

Cogan syndrome (4)

A

Rare, large vessel vasculitis affecting children and young adults.
Favours eyes, causing optic neuritis, uveitis and audiovestivular symptosm (resembles Menieres).
Can get aortitis - worse prognosis.
“kid with eye and ear symptoms +/- aortitis”

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8
Q

PAN - features (4)

A

More common in men.
Commonly affects renal (90%), cardiac (70%) and GI (50-70%).
Microaneurysm formation, mainly at branch points, followed by infarction.
Imaging: Kidneys with microaneurysms and multiple areas of wedge shaped infarct.

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9
Q

PAN - trivia (2)

A

Associated with Hep B.
Microaneurysm formation in kidneys can also be seen in people who abuse crystal meth.

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10
Q

Kawasaki disease

A

Commonest vasculitis in kids.
Common cause of coronary artery aneurysm (Calcified coronary artery aneurysm on CXR is an aunt minnie).
Other buzzwords
“Mucocotaneous lymph node syndrome”
“Fever for 5 days”

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11
Q

Coronary artery aneurysms - prognosis (2)

A

> 8mm are Giant, prone to poor outcomes including MI
<8mm may regress

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12
Q

Wegeners (Granulomatosis with Polyangiitis) - (3)

A

Affects upper resp tract (sinuses), lower resp tract (lungs) and kidneys.
cANCA + (90%).
Imaging: nasal perforation and cavitating lung lesions.

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13
Q

Churg strauss - (5)

A

Necrotising pulmonary vasculitis, within spectrum of eosinophilic lung disease.
Always have asthma and eosinophilia.
Imaging: Transient peripheral consolidation or ground glass.
Cavitation is rare (think Wegeners instead).
pANCA + (75%)

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14
Q

Microscopic polyangiitis - (3)

A

Affects kidneys and lungs.
1/3 get diffuse pulmonary haemorrhage.
pANCA + (80%)

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15
Q

HSP (Henoch-Schlonlein Purpura) - trivia (3)

A

Commonest vasculitis in kids (common age 4-11).
Systemic disease. GI symptoms most common (pain, bloody diarrhoea).
Common lead point for intussusception.

16
Q

HSP - imaging (3)

A

US: donut sign of intussusception
US: scrotum showing massive skin oedema
Can get multifocal bowel wall thickening.

17
Q

Behcets (2)

A

Mouth ulcers and genital ulcers in Turkish person.
Can cause aortic thickening, and pulmonary artery aneurysm.

18
Q

Buergers (4)

A

Vasculitis, strong smoking association.
Affects small and medium vessels in arms and legs (most commonly legs).
Imaging: hand angio showing extensive arterial occlusions with corkscrew collaterals developing.
Usually affects multiple limbs, can lead to “Auto-amputation”

19
Q

Hand angiogram DDx (4)

A

Will usually be either Buergers or Hypothenar Hammer Syndrome (HHS).
Ulnar artery involved = HHS (look for pseudo-aneurysm of ulnar artery).
Ulnar artery not involved - look at fingers
- If occlusions within fingers, suggests Buergers. May have corkscrew collaterals to confirm.
HHS can cause finger occlusions from distal emboli, but the ulnar artery will also be affected.

20
Q

Vasculitis - location DDx

A

Most commonly:
Central = Takayasu
Mid clavicle = Thoracic outlet syndrome
Armpit = Giant Cell

21
Q

SAM (Segmental arterial mediolysis) - (4)

A

Affects splanchnic arteries in elderly, coronaries in young adults.
Not true vasculitis, no significant inflammation.
Degeneration of tunica media, causing often multiple aneurysms.
Imaging - Multiple abdominal splanchnic artery saccular aneurysms.

22
Q

Cystic adventitial disease (3)

A

Rare, affects popliteal artery in young men.
Multiple mucoid filled cysts in outer media and adventitia.
Cysts compress the artery as they grow.