Vasculitis



Vasculitis


Michael P. Federle, MD, FACR

Amir A. Borhani, MD





Key Facts


Terminology



  • Diverse group of diseases characterized by inflammation and necrosis of blood vessels


  • Classified based on type of vessels predominantly involved


  • Large-vessel vasculitides



    • Takayasu arteritis, giant cell arteritis


  • Medium-sized vessel vasculitides



    • Polyarteritis nodosa (PAN), Kawasaki disease


  • Small-vessel vasculitides



    • Wegener granulomatosis, Churg-Strauss disease, microscopic polyangiitis, Henoch-Schönlein purpura, lupus vasculitis, Behçet disease


Imaging



  • Takayasu arteritis



    • Stenosis of aorta and its main branches


  • PAN



    • Multiple aneurysms in renal and mesenteric arteries


  • HSP



    • Bowel wall thickening and luminal narrowing; purpuric rash


  • Wegener granulomatosis



    • Renal and perirenal hemorrhage are common


  • Lupus vasculitis



    • Hypercoagulable state; bowel and renal ischemic injury


  • Behçet disease



    • Deep ulceration of bowel with danger of perforation


Diagnostic Checklist



  • CT findings that look like bowel or renal ischemia in young person should raise concern for vasculitis






(Left) Axial CECT in a 21-year-old woman with severe abdominal pain shows wedge-shaped defects in the kidneys image representing acute ischemic injury. (Right) Axial CECT in the same patient shows long segment bowel wall thickening and submucosal edema image, findings compatible with enteric ischemia. Rheumatoid vasculitis was subsequently confirmed.






(Left) Axial CECT in the same patient shows additional renal image and bowel image ischemic injuries. (Right) Axial CECT in the same patient shows additional segments of bowel wall edema image. In a young patient, these findings of bowel and renal ischemic or inflammatory disease without other explanation are almost diagnostic of some form of vasculitis.



TERMINOLOGY


Definitions



  • Diverse group of diseases characterized by inflammation and necrosis of blood vessels


  • Takayasu arteritis: Vasculitis affecting aorta and its main branches


  • Polyarteritis nodosa (PAN): Fibrinoid necrotizing vasculitis involving small and medium-sized vessels


  • Henoch-Schönlein purpura (HSP): Hypersensitivityrelated acute vasculitis affecting small vessels


  • Wegener granulomatosis: Granulomatous vasculitis of respiratory tract and kidneys


  • Lupus vasculitis: Necrotizing vasculitis affecting small vessels


  • Behçet disease: Necrotizing vasculitis of small vessels affecting multiple organs


IMAGING


General Features

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Jun 8, 2016 | Posted by in GENERAL RADIOLOGY | Comments Off on Vasculitis

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