Pediatric vasculitis: recognizing multisystemic manifestations at body imaging

Area of Science:

• Pediatric rheumatology and radiology

Background:

• Pediatric vasculitides are complex multisystem diseases with diverse clinical presentations.
• Accurate diagnosis and timely intervention are critical for favorable outcomes, as delays can lead to severe or fatal consequences.
• Henoch-Schönlein purpura and Kawasaki disease are the most prevalent forms of pediatric vasculitis.

Purpose of the Study:

• To review the classification and clinical features of major pediatric vasculitides.
• To outline the imaging approach for diagnosing pediatric vasculitis involving large- and medium-sized vessels.
• To discuss nonneurologic imaging findings in common pediatric vasculitis subtypes for pediatric body imagers.

Main Methods:

• Review of current literature on pediatric vasculitis classification and clinical manifestations.
• Analysis of the role of imaging in diagnosing and monitoring pediatric vasculitis.
• Focus on imaging modalities for large- and medium-vessel vasculitis and indirect signs in small-vessel vasculitis.

Main Results:

• Clinical manifestations of pediatric vasculitis vary based on vessel size, organ involvement, and pathology.
• Imaging is essential for diagnosing large- and medium-vessel vasculitis, assessing vascular and extravascular involvement, and monitoring treatment response.
• While direct visualization of small-vessel changes is limited, imaging can detect secondary tissue damage.

Conclusions:

• Pediatric vasculitides require a thorough understanding of their varied presentations for accurate diagnosis.
• Imaging techniques are indispensable tools in the diagnostic workup and management of pediatric vasculitis, particularly for larger vessels.
• A comprehensive imaging approach, considering both direct and indirect signs, is vital for effective patient care.