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Diagnosis of early Takayasu arteritis with sonography
W A Schmidt1, A Nerenheim, E Seipelt
1Medical Centre for Rheumatology Berlin-Buch, Berlin, Germany.
Insights
Sonography can detect early Takayasu arteritis in young females before significant arterial narrowing occurs. This imaging technique helps identify inflammation in the carotid and subclavian arteries, aiding timely diagnosis.
Area of Science:
- Vascular Medicine
- Rheumatology
- Diagnostic Imaging
Background:
- Takayasu arteritis is a large-vessel vasculitis primarily affecting young females.
- Diagnosis is often delayed until arterial stenoses or occlusions are evident.
- Early detection is crucial for effective management.
Purpose of the Study:
- To evaluate the utility of sonography in the early diagnosis of Takayasu arteritis.
- To compare sonographic findings in early-stage disease versus stenotic/occlusive stages.
Main Methods:
- Retrospective comparison of three patients with early Takayasu arteritis and nine patients with diagnosed stenotic/occlusive disease.
- All patients were German Caucasian females.
- Color Doppler sonography and angiography were performed for all participants.
Main Results:
- Early-stage patients presented with fatigue, arthralgia, and inflammation, lacking typical vascular signs.
- Sonography revealed characteristic wall thickening in the carotid and subclavian arteries in early disease.
- Angiography was less definitive in early stages, while sonography confirmed inflammation in later stages.
Conclusions:
- Sonography effectively aids in detecting early Takayasu arteritis.
- Investigating the primary extracranial branches of the aortic arch via sonography is recommended for young females with unexplained inflammation and symptoms.
Objective:
Takayasu arteritis is a large-vessel vasculitis that occurs predominantly in young females. The diagnosis is not usually established before arterial stenoses or occlusions are present. The aim of the study was to find out if sonography can aid in the diagnosis of the disease in earlier stages.
Methods:
We describe three patients with early disease who had no haemodynamically relevant stenoses. They are compared with nine patients who were diagnosed in the stenotic/occlusive stage of the disease. All patients were German Caucasian females. Colour Doppler sonography and angiography were performed in all cases.
Results:
Patients with early disease had general symptoms of fatigue and arthralgia and laboratory signs of inflammation, but neither bruits nor decrease of pulse rate. Sonography of the carotid and subclavian arteries demonstrated a characteristic, homogeneous, midechoic, circumferential thickening of the wall. At this stage of the disease it was difficult to get unequivocal results with angiography. In all nine remaining patients, sonography also demonstrated inflammation of the subclavian or carotid arteries, as did angiography in eight of these patients.
Conclusion:
Sonography of the carotid and subclavian arteries aids in the detection of early Takayasu arteritis. In young females with unclear symptoms and laboratory findings of generalized inflammation, the primary extracranial branches of the aortic arch should be investigated by sonography to detect early Takayasu arteritis.
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