Vasculitis

Question 1

Takayasu arteritis (epidemiology, clinical features and imaging findings, treatment)

Answer 1

Large vessel, young to middle aged females (F:M = 9:1), Asia/India/SA. Present with ischemia symptoms specific (neuro, bowel, claudication)

Affects the aorta, first order branches and pulmonary arteries. Long smooth stenoses or occlusions of the vessels +/- aneurysms.

Imaging
US: smooth, concentric thickening of the wall of the arteries (‘macaroni sign’), esp internal carotids
CT: wall thickening +/- enhancement, aortic valve disease, occlusion or stenosis of aorta and its major branches, aneurysmal dilation
May also have coronary artery stenosis.

Tx: steroids +/- angioplasty

Question 2

Giant cell arteritis (epidemiology, clinical features and imaging findings, treatment)

Answer 2

Large and medium vessel vasculitis, Scandinavian patients, age >50, acutely present with fever, headache, myalgia, scalp tenderness.

Imaging
Long smooth stenoses or occlusions usually involving the external carotid arteries and its branches. If extra-cranial, usually involves the distal subclavian or axillary artery.

Temporal artery biopsy gold standard. C+ MRI may show mural thickening and enhancement.

Question 3

What is Buerger Disease? What patients are at risk? What are the imaging findings?

Answer 3

• Small to medium size vasculitis
• Starts as occlusive thrombus then vessel becomes fibrotic
• Almost exclusively affects the extremities, below elbows and knees (lower > upper); involves >1 limb
• All patients are smokers or have used tobacco products
• ** Common cause of severe chronic limb ischemia in smokers under the age of 40 - disease will remit if pts stop smoking.

Imaging: abrupt occlusions of distal arteries with normal skip areas, corkscrew/tortuous collateral vessels.

Question 4

Polyarteritis nodosa (PAN) (epidemiology, clinical features and imaging findings, treatment)

Answer 4

• Small to medium size vasculitis
• Middle aged patients., M>F, associated with Hep B & C
• Can involve kidneys (#1), GI tract (#2), spleen, liver, skin, peripheral nerves and muscles

Imaging:
Multiple small (<1 cm) saccular aneurysms and occlusions of distal arteries
Hemorrhage and/or infarcts in the affected organs

Question 5

Which panvasculitis is associated with multiple, bilateral lower lobe pulmonary artery aneurysms? And what are the clinical manifestations of this disease?

Answer 5

Behcets disease

Oral ulcers, genital ulcers and uveitis

Question 6

Imaging findings of Kawasaki’s disease

Answer 6

Medium sized vessels affecting children: coronary artery aneurysms or stenoses, myocarditis