Imaging of systemic vasculitis in childhood

Soliman, Mahmoud A.; Laxer, Ronald M.; Manson, David; Yeung, Rae S. M.; Doria, A.

doi:10.1007/s00247-015-3339-3

Cited by 26 publications

(59 citation statements)

References 49 publications

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“…Diagnostic algorithms have been proposed to improve the differentiation causes of vasculopathy [5,8].…”

Section: Introductionmentioning

confidence: 99%

“…The diagnosis of vasculopathy in the middle aortic syndrome is based on clinical, laboratory and angiographic imaging. Computed tomography angiography (CTA) and magnetic resonance angiography (MRA) can delineate the characteristic changes in vessel anatomy, such as wall thickening, wall enhancement, and alternating focal areas of luminal narrowing and dilatation [8,[13][14][15]. However, the 18F-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography combined with anatomical CT angiography (PET/CTA) may be the first imaging examination to help identify the occurrence of inflammation in the vascular walls.…”

Section: Introductionmentioning

confidence: 99%

“…However, the 18F-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography combined with anatomical CT angiography (PET/CTA) may be the first imaging examination to help identify the occurrence of inflammation in the vascular walls. FDG PET/CTA have the potential to recognize early vessel wall inflammation and may also detect vasculitis before anatomic changes are recognizable at CTA or MRA [8,13,14].…”

Section: Introductionmentioning

confidence: 99%

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The importance of FDG PET/CT in the diagnostic process of the middle aortic syndrome in a 15-year-old boy patient with suspected systemic vasculitis and final diagnosis of Williams–Beuren syndrome

et al. 2020

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The differential diagnosis in children with the systemic vasculopathy is still a challenge for clinicians. The progress in vascular imaging and the latest recommendations improve the diagnostic process, but only single reports describe the use of new imaging tests in children. The publication aims to demonstrate the important role of 18F-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography combined with anatomical computed tomography angiography (PET/CTA) imaging in the case of a 15-year-old boy with chest pain, intermittent claudication, hypertension and features of middle aortic syndrome in computed tomography angiography (CTA). The patient was suspected to have Takayasu arteritis, but was finally diagnosed with Williams-Beuren syndrome. The case indicates that the FDG PET/CT imaging might be essential in the diagnostic process of middle aortic syndrome in children. We suggest that this imaging technique should be considered in the diagnostic process of systemic vasculopathy particularly in children.

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“…Diagnostic algorithms have been proposed to improve the differentiation causes of vasculopathy [5,8].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The importance of FDG PET/CT in the diagnostic process of the middle aortic syndrome in a 15-year-old boy patient with suspected systemic vasculitis and final diagnosis of Williams–Beuren syndrome

et al. 2020

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“…The diagnosis can be made on history and physical exam alone, as no specific laboratory test or imaging is diagnostic [5]. …”

Section: Introductionmentioning

confidence: 99%

A case of Henoch-Schonlein Purpura with dilated coronary arteries

et al. 2018

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BackgroundHenoch-Schonlein Purpura (HSP) is one of the most common vasculitides of childhood, with 10–20 cases per 100,000 children. It frequently occurs following an infectious trigger and involves IgA and C3 deposition in small vessel walls. HSP is characterized by palpable purpura plus IgA deposition on biopsy, arthritis/arthralgia, renal involvement (hematuria and/or proteinuria), and/or abdominal pain. It is not generally recognized as a cause of dilated coronary arteries.Case presentationWe describe the first reported case of HSP presenting with dilated coronary arteries. This patient is a nine-year-old previously healthy Caucasian male who presented with 1 week of petechiae on his lower legs, knee and ankle arthritis, and abdominal pain without fever, consistent with HSP. An echocardiogram revealed coronary dilation, including the left main (5.32 mm, Z score + 4.25) and left anterior descending (LAD) (3.51 mm, Z score + 2.64) coronary arteries. He received high dose aspirin, IVIG, and infliximab with normalization of the LAD. Skin biopsy revealed leukocytoclastic vasculitis with positive IgA staining. He was Rhinovirus/Enterovirus positive with Group A Streptococcus on throat culture.ConclusionCardiac findings, while rare, can exist in HSP. Coronary dilation appeared to respond to our hospital protocol’s Kawasaki Disease (KD) therapy, possibly indicating an overlap in HSP and KD pathophysiology. This case, along with prior reports of dilated coronaries in systemic juvenile idiopathic arthritis (SJIA), highlights the importance of considering other sources of systemic inflammation, in addition to KD, when coronary dilation is identified. The appropriate therapy, follow-up, and prognosis for our patient are not clear, as further studies are needed to determine the natural course of these findings.

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“…Conventional angiography has been the reference standard for imaging TA and allows evaluation of the vessel lumen. However, angiography is invasive and provides ionizing radiation [ 2 , 3 ], which are particularly important considerations in the evaluation of a child. Additionally, early inflammatory changes to the vessel include mural edema, wall thickening, and wall enhancement, which may be demonstrated on cross-sectional imaging, allowing earlier detection of disease prior to the development of stenosis, occlusion, or aneurysms [ 1 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

The Utility of MRI in the Diagnosis of Takayasu Arteritis

Gaballah

Goldfisher

Amodio

2017

Case Reports in Pediatrics

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Takayasu Arteritis (TA) is an inflammatory disorder involving the thoracoabdominal aorta and its branches and the pulmonary arteries, with eventual vascular stenosis, occlusion, or aneurysm formation. Conventional angiography has been the reference imaging standard for diagnosis of TA. The purpose of this case report is to demonstrate the utility of MR imaging and MR angiography in the diagnosis of Takayasu Arteritis in a pediatric patient. The patient is a 15-year-old female patient presenting with anemia, hypertension, and acute kidney injury. Initial chest CT demonstrated ectasia of the ascending and focal stenosis of the descending thoracic aorta, prompting further evaluation with MRI and MRA. MRI/MRA demonstrated mural thickening with luminal stenosis of the aorta and aortic branch vessels. These imaging findings were suggestive of a large vessel arteritis and along with the clinical presentation and laboratory abnormalities the diagnosis of Takayasu Arteritis was suggested. Several case series in adults have described the cross-sectional findings of TA. However, this case report demonstrates the utility of MRI/MRA in the evaluation of TA in children and in the course of follow-up, as it provides a noninvasive method for evaluating a child without ionizing radiation or iodinated contrast.

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Imaging of systemic vasculitis in childhood

Cited by 26 publications

References 49 publications

The importance of FDG PET/CT in the diagnostic process of the middle aortic syndrome in a 15-year-old boy patient with suspected systemic vasculitis and final diagnosis of Williams–Beuren syndrome

The importance of FDG PET/CT in the diagnostic process of the middle aortic syndrome in a 15-year-old boy patient with suspected systemic vasculitis and final diagnosis of Williams–Beuren syndrome

A case of Henoch-Schonlein Purpura with dilated coronary arteries

The Utility of MRI in the Diagnosis of Takayasu Arteritis

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