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de Moreuil C, Rouvière B, Rezig S, Le Duc-Pennec A, Quintin-Roué I, Bressollette L, Hoffmann C. An atypical lower limb pain revealing a possible systemic venous vasculitis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:164-166. [PMID: 32329519 DOI: 10.1002/jcu.22853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 04/10/2020] [Accepted: 04/12/2020] [Indexed: 06/11/2023]
Abstract
We describe a possible systemic vasculitis involving electively large veins. The patient presented with severe febrile lower limb pain. Diagnosis was made by color Doppler ultrasound (CDU) and confirmed by anatomopathological examination of the long saphenous vein, but not by examination of the temporal artery which was normal. CDU found a unilateral halo sign of one temporal artery and a major wall swelling of the lower limb proximal deep veins. The etiology of this possible vasculitis is still unknown. It could be an unusual clinical presentation of giant cell arteritis with vein involvement but without proven arterial involvement. To confirm this hypothesis, it would be interesting to look systematically for lower limb vein thickening with CDU in patients newly diagnosed with giant cell arteritis who have lower limb pain.
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Affiliation(s)
- Claire de Moreuil
- Département de médecine vasculaire, médecine interne et pneumologie, CHU de Brest, Hôpital La Cavale Blanche, Brest Cedex, France
- EA 3878, GETBO, Université Bretagne Loire, Brest Cedex, France
| | - Bénédicte Rouvière
- Département de médecine vasculaire, médecine interne et pneumologie, CHU de Brest, Hôpital La Cavale Blanche, Brest Cedex, France
| | - Schéhérazade Rezig
- Service de Maladies infectieuses et tropicales, CHU de Brest, Hôpital La Cavale Blanche, Brest Cedex, France
| | - Alexandra Le Duc-Pennec
- Département de médecine nucléaire, CHU de Brest, Hôpital La Cavale Blanche, Brest Cedex, France
| | | | - Luc Bressollette
- Département de médecine vasculaire, médecine interne et pneumologie, CHU de Brest, Hôpital La Cavale Blanche, Brest Cedex, France
- EA 3878, GETBO, Université Bretagne Loire, Brest Cedex, France
| | - Clément Hoffmann
- Département de médecine vasculaire, médecine interne et pneumologie, CHU de Brest, Hôpital La Cavale Blanche, Brest Cedex, France
- EA 3878, GETBO, Université Bretagne Loire, Brest Cedex, France
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Svensson C, Eriksson P, Zachrisson H. Vascular ultrasound for monitoring of inflammatory activity in Takayasu arteritis. Clin Physiol Funct Imaging 2019; 40:37-45. [DOI: 10.1111/cpf.12601] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 10/07/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Christina Svensson
- Department of Clinical Physiology University Hospital Linköping Sweden
- Department of Medicine and Health Science Division of Clinical Physiology Linköping University Linköping Sweden
| | - Per Eriksson
- Rheumatology/Division of Neuro and Inflammation Sciences Department of Clinical and Experimental Medicine Division of Rheumatology Faculty of Health Sciences Linköping University Linköping Sweden
| | - Helene Zachrisson
- Department of Clinical Physiology University Hospital Linköping Sweden
- Department of Medicine and Health Science Division of Clinical Physiology Linköping University Linköping Sweden
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Ponte C, Águeda A, Luqmani R. Clinical features and structured clinical evaluation of vasculitis. Best Pract Res Clin Rheumatol 2018; 32:31-51. [DOI: 10.1016/j.berh.2018.10.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 09/14/2018] [Indexed: 10/27/2022]
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Zachrisson H, Svensson C, Dremetsika A, Eriksson P. An extended high-frequency ultrasound protocol for detection of vessel wall inflammation. Clin Physiol Funct Imaging 2017; 38:586-594. [DOI: 10.1111/cpf.12450] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 05/31/2017] [Indexed: 11/29/2022]
Affiliation(s)
- H. Zachrisson
- Department of Clinical Physiology; Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - C. Svensson
- Department of Clinical Physiology; Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - A. Dremetsika
- Department of Rheumatology; Department of Clinical and Experimental Medicine; County Council of Östergötland; Linköping University and Department of Rheumatology; Linköping Sweden
| | - P. Eriksson
- Department of Rheumatology; Department of Clinical and Experimental Medicine; County Council of Östergötland; Linköping University and Department of Rheumatology; Linköping Sweden
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Khosla A, Andring B, Atchie B, Zerr J, White B, MacFarlane J, Kalva SP. Systemic Vasculopathies. Radiol Clin North Am 2016; 54:613-28. [DOI: 10.1016/j.rcl.2015.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Kato Y, Terashima M, Ohigashi H, Tezuka D, Ashikaga T, Hirao K, Isobe M. Vessel Wall Inflammation of Takayasu Arteritis Detected by Contrast-Enhanced Magnetic Resonance Imaging: Association with Disease Distribution and Activity. PLoS One 2015; 10:e0145855. [PMID: 26720837 PMCID: PMC4700986 DOI: 10.1371/journal.pone.0145855] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 12/09/2015] [Indexed: 11/18/2022] Open
Abstract
AIMS The assessment of the distribution and activity of vessel wall inflammation is clinically important in patients with Takayasu arteritis. Magnetic resonance imaging (MRI) is a useful tool, but the clinical utility of late gadolinium enhancement (LGE) in Takayasu arteritis has yet to be determined. The aim of the present study was to evaluate the utility of LGE in assessing vessel wall inflammation and disease activity in Takayasu arteritis. METHODS AND RESULTS We enrolled 49 patients with Takayasu arteritis who had undergone 1.5 T MRI. Patients were divided into Active (n = 19) and Inactive disease (n = 30) groups. The distribution of vessel wall inflammation using angiography and LGE was assessed by qualitative analysis. In 79% and 63% of patients in Active and Inactive groups, respectively, greater distribution of vessel wall inflammation was observed with LGE than with conventional angiography. MRI values of pre- and post-contrast signal-to-noise ratios (SNR), SNR increment (post-SNR minus pre-SNR), pre- and post-contrast contrast-to-noise ratios (CNR), and CNR increment (post-CNR minus pre-CNR) were evaluated at arterial wall sites with the highest signal intensity using quantitative analysis of post-contrast LGE images. No statistically significant differences in MRI parameters were observed between Active and Inactive groups. Contrast-enhanced MRI was unable to accurately detect active disease. CONCLUSION Contrast-enhanced MRI has utility in detecting the distribution of vessel wall inflammation but has less utility in assessing disease activity in Takayasu arteritis.
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Affiliation(s)
- Yoko Kato
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
- Cardiovascular Imaging Clinic, Tokyo, Japan
| | | | - Hirokazu Ohigashi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Daisuke Tezuka
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takashi Ashikaga
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kenzo Hirao
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mitsuaki Isobe
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
- * E-mail:
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Ammirati E, Moroni F, Pedrotti P, Scotti I, Magnoni M, Bozzolo EP, Rimoldi OE, Camici PG. Non-invasive imaging of vascular inflammation. Front Immunol 2014; 5:399. [PMID: 25183963 PMCID: PMC4135304 DOI: 10.3389/fimmu.2014.00399] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 08/05/2014] [Indexed: 11/16/2022] Open
Abstract
In large-vessel vasculitides, inflammatory infiltrates may cause thickening of the involved arterial vessel wall leading to progressive stenosis and occlusion. Dilatation, aneurysm formation, and thrombosis may also ensue. Activated macrophages and T lymphocytes are fundamental elements in vascular inflammation. The amount and density of the inflammatory infiltrate is directly linked to local disease activity. Additionally, patients with autoimmune disorders have an increased cardiovascular (CV) risk compared with age-matched healthy individuals as a consequence of accelerated atherosclerosis. Molecular imaging techniques targeting activated macrophages, neovascularization, or increased cellular metabolic activity can represent effective means of non-invasive detection of vascular inflammation. In the present review, novel non-invasive imaging tools that have been successfully tested in humans will be presented. These include contrast-enhanced ultrasonography, which allows detection of neovessels within the wall of inflamed arteries; contrast-enhanced CV magnetic resonance that can detect increased thickness of the arterial wall, usually associated with edema, or mural enhancement using T2 and post-contrast T1-weighted sequences, respectively; and positron emission tomography associated with radio-tracers such as [18F]-fluorodeoxyglucose and the new [11C]-PK11195 in combination with computed tomography angiography to detect activated macrophages within the vessel wall. Imaging techniques are useful in the diagnostic work-up of large- and medium-vessel vasculitides, to monitor disease activity and the response to treatments. Finally, molecular imaging targets can provide new clues about the pathogenesis and evolution of immune-mediated disorders involving arterial vessels.
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Affiliation(s)
- Enrico Ammirati
- Cardiothoracic Department, San Raffaele Scientific Institute and University , Milan , Italy ; Cardiovascular and Thoracic Department, AO Ospedale Niguarda Ca' Granda , Milan , Italy
| | - Francesco Moroni
- Cardiothoracic Department, San Raffaele Scientific Institute and University , Milan , Italy
| | - Patrizia Pedrotti
- Cardiovascular and Thoracic Department, AO Ospedale Niguarda Ca' Granda , Milan , Italy
| | - Isabella Scotti
- Cardiothoracic Department, San Raffaele Scientific Institute and University , Milan , Italy
| | - Marco Magnoni
- Cardiothoracic Department, San Raffaele Scientific Institute and University , Milan , Italy
| | - Enrica P Bozzolo
- Unit of Medicine and Clinical Immunology, Department of Medicine, San Raffaele Scientific Institute and University , Milan , Italy
| | - Ornella E Rimoldi
- Cardiothoracic Department, San Raffaele Scientific Institute and University , Milan , Italy ; CNR Istituto di Bioimmagini e Fisiologia Molecolare , Segrate, Milan , Italy
| | - Paolo G Camici
- Cardiothoracic Department, San Raffaele Scientific Institute and University , Milan , Italy
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Schmidt WA. Role of ultrasound in the understanding and management of vasculitis. Ther Adv Musculoskelet Dis 2014; 6:39-47. [PMID: 24688604 DOI: 10.1177/1759720x13512256] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Vasculitis is characterized by a circumferential vessel-wall thickening ('halo'), which can be visualized by modern imaging techniques. In particular, the resolution of ultrasound has increased to 0.1 mm. Ultrasound detects abnormalities that are pathognomonic even in arteries with a diameter below 1 mm. It is particularly helpful in the diagnosis of large-vessel vasculitides, such as classic temporal arteritis, large-vessel giant-cell arteritis (GCA), Takayasu arteritis and idiopathic aortitis. Echocardiography is important for determining cardiac involvement in Takayasu arteritis and also for examining the coronary arteries of children with suspected Kawasaki disease, which is a medium-vessel vasculitis. In small vessel vasculitides ultrasound has only a role for determining the distribution or organ involvement. Fast-track clinics for the diagnosis of GCA help to initiate treatment before complications such as blindness occur; patients receive appointments within 24 h in these clinics. Clinical examination and ultrasound of temporal and axillary arteries are performed by an experienced rheumatologist. In most cases this is able to determine if GCA is present. Temporal artery biopsy can be still carried out in ambivalent cases. The wall swelling of temporal arteries disappears after 2-3 weeks of glucocorticoid treatment. After 3 days of treatment, diagnosis becomes more difficult with ultrasound in some cases. In larger arteries, such as the axillary arteries, wall thickening disappears within months. It tends to be darker (more hypoechoic) in acute disease because of oedema.
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Affiliation(s)
- Wolfgang A Schmidt
- Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology Berlin-Buch, Lindenberger Weg 19, 13125 Berlin, Germany
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