The Role of Noninvasive Imaging in Early Diagnosis of Clinically Masked Prepulseless Inflammatory Phase of Takayasu's Arteritis

Abstract

Diagnosis of early-phase Takayasu's arteritis (TA) is extremely difficult and overlooked as most often presentation is nonspecific and mimics various other diseases. Early diagnosis and initiation of proper therapy could alter the natural course of the disease. We describe an adolescent male presenting with pyrexia of unknown origin and clinical features simulating idiopathic dilated cardiomyopathy. Transthoracic echocardiography was suggestive of dilated cardiomyopathy with severe left ventricular dysfunction. Later vascular ultrasonography and CT aortography showed extensive thickening of intima-media of aorta and its major branches suggestive of inflammatory phase of TA. We discuss the role of noninvasive imaging in diagnosis of clinically masked prepulseless inflammatory phase of TA.

Ultrasonography as a Diagnostic Support Tool for Childhood Takayasu Arteritis Referred to as Fever of Unknown Origin: Case Series and Literature Review

“…According to the search strategy, inclusion and exclusion criteria, 12 articles including 13 cases were reviewed (9) , (10) , (11) , (12) , (13) , (14) , (15) , (16) , (17) , (18) , (19) , (20) . Figure 2 shows a flowchart depicting the article screening and selection.…”

Ultrasound of type 4 Takayasu's arteritis with abdominal aorta and visceral artery stenosis

“…Digital subtraction angiography has historically been the gold standard for classifying TAK . Recent advances in computed tomography angiography, MRA and ultrasound allow less invasive assessment of TAK, identifying wall thickening of affected vessels prior to visualisation of a narrowed or occluded lumen with digital subtraction angiography . Clinical symptoms related to TAK include bruits, difficulty palpating for a pulse and asymmetric arm pressures .…”

“…Unlike atherosclerosis, TAK affects all layers of the arterial wall, this can reduce the effectiveness of angioplasty and as such restenosis can be common . Early diagnosis in the pre‐stenotic phase is essential for early medical treatment, improving the patient's prognosis and to limit morbidity …”

Role of Contrast-Enhanced Ultrasound Sonography in the Medical Diagnostics of the Disease Activity in Patients With Takayasu Arteritis

“…Ultrasound can effectively demonstrate thickening of the vessel wall, which may be an earlier symptom of the disease occurring before stenosis and dilatation [2]. Conventional ultrasound, color doppler flow imaging (CDFI), and pulse doppler imaging (PDI) can detect TA through thickening of the arterial wall, stenosis of the lumen, or occlusion [15], but they are failed to assess the disease activity as they can not demonstrate vasa vasorums or slight thickening of the arterial wall. Ultrasound contrast agent can act as red blood cell tracers to evaluate microcirculation and improve image quality significantly [16].…”