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Thangathurai J, Kalashnikova M, Takahashi M, Shinbane JS. Coronary Artery Aneurysm in Kawasaki Disease: Coronary CT Angiography through the Lens of Pathophysiology and Differential Diagnosis. Radiol Cardiothorac Imaging 2021; 3:e200550. [PMID: 34778780 DOI: 10.1148/ryct.2021200550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 07/21/2021] [Accepted: 09/13/2021] [Indexed: 12/17/2022]
Abstract
Kawasaki disease (KD) is an inflammatory autoimmune vasculitis affecting the coronary arteries of very young patients, which can result in coronary artery aneurysms (CAAs) with lifelong manifestations. Accurate identification and assessment of CAAs in the acute phase and sequentially during the chronic phase of KD is fundamental to the treatment plan for these patients. The differential diagnosis of CAA includes atherosclerosis, other vasculitic processes, connective tissue disorders, fistulas, mycotic aneurysms, and procedural sequelae. Understanding of the initial pathophysiology and evolutionary arterial changes is important to interpretation of imaging findings. There are multiple applicable imaging modalities, each with its own strengths, limitations, and role at various stages of the disease process. Coronary CT angiography is useful for evaluation of CAAs as it provides assessment of the entire coronary tree, CAA size, structure, wall, and lumen characteristics and visualization of other cardiothoracic vasculature. Knowledge of the natural history of KD, the spectrum of other conditions that can cause CAA, and the strengths and limitations of cardiovascular imaging are all important factors in imaging decisions and interpretation. Keywords: Pediatrics, Coronary Arteries, Angiography, Cardiac © RSNA, 2021.
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Affiliation(s)
- Jenica Thangathurai
- Department of Medicine, Division of Cardiology, Harbor-University of California, Los Angeles Medical Center, 1124 W Carson St, RB-2 3rd Floor, Torrance, CA 90502 (J.T.); Department of Medicine, Brigham and Women's Hospital and Harvard School of Medicine, Boston, Mass (M.K.); Department of Pediatrics, University of Washington School of Medicine and Heart Center, Seattle Children's Hospital, Seattle, Wash (M.T.); and Division of Cardiovascular Medicine, Keck School of Medicine of the University of Southern California, Health Science Campus, Los Angeles, Calif (J.S.S.)
| | - Mariya Kalashnikova
- Department of Medicine, Division of Cardiology, Harbor-University of California, Los Angeles Medical Center, 1124 W Carson St, RB-2 3rd Floor, Torrance, CA 90502 (J.T.); Department of Medicine, Brigham and Women's Hospital and Harvard School of Medicine, Boston, Mass (M.K.); Department of Pediatrics, University of Washington School of Medicine and Heart Center, Seattle Children's Hospital, Seattle, Wash (M.T.); and Division of Cardiovascular Medicine, Keck School of Medicine of the University of Southern California, Health Science Campus, Los Angeles, Calif (J.S.S.)
| | - Masato Takahashi
- Department of Medicine, Division of Cardiology, Harbor-University of California, Los Angeles Medical Center, 1124 W Carson St, RB-2 3rd Floor, Torrance, CA 90502 (J.T.); Department of Medicine, Brigham and Women's Hospital and Harvard School of Medicine, Boston, Mass (M.K.); Department of Pediatrics, University of Washington School of Medicine and Heart Center, Seattle Children's Hospital, Seattle, Wash (M.T.); and Division of Cardiovascular Medicine, Keck School of Medicine of the University of Southern California, Health Science Campus, Los Angeles, Calif (J.S.S.)
| | - Jerold S Shinbane
- Department of Medicine, Division of Cardiology, Harbor-University of California, Los Angeles Medical Center, 1124 W Carson St, RB-2 3rd Floor, Torrance, CA 90502 (J.T.); Department of Medicine, Brigham and Women's Hospital and Harvard School of Medicine, Boston, Mass (M.K.); Department of Pediatrics, University of Washington School of Medicine and Heart Center, Seattle Children's Hospital, Seattle, Wash (M.T.); and Division of Cardiovascular Medicine, Keck School of Medicine of the University of Southern California, Health Science Campus, Los Angeles, Calif (J.S.S.)
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Leone P, Prete M, Malerba E, Bray A, Susca N, Ingravallo G, Racanelli V. Lupus Vasculitis: An Overview. Biomedicines 2021; 9:1626. [PMID: 34829857 PMCID: PMC8615745 DOI: 10.3390/biomedicines9111626] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/29/2021] [Accepted: 11/03/2021] [Indexed: 12/21/2022] Open
Abstract
Lupus vasculitis (LV) is one of the secondary vasculitides occurring in the setting of systemic lupus erythematosus (SLE) in approximately 50% of patients. It is most commonly associated with small vessels, but medium-sized vessels can also be affected, whereas large vessel involvement is very rare. LV may involve different organ systems and present in a wide variety of clinical manifestations according to the size and site of the vessels involved. LV usually portends a poor prognosis, and a prompt diagnosis is fundamental for a good outcome. The spectrum of involvement ranges from a relatively mild disease affecting small vessels or a single organ to a multiorgan system disease with life-threatening manifestations, such as mesenteric vasculitis, pulmonary hemorrhage, or mononeuritis multiplex. Treatment depends upon the organs involved and the severity of the vasculitis process. In this review, we provide an overview of the different forms of LV, describing their clinical impact and focusing on the available treatment strategies.
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Affiliation(s)
- Patrizia Leone
- Department of Biomedical Sciences and Human Oncology, “Aldo Moro” University of Bari Medical School, 70124 Bari, Italy; (P.L.); (M.P.); (E.M.); (A.B.); (N.S.)
| | - Marcella Prete
- Department of Biomedical Sciences and Human Oncology, “Aldo Moro” University of Bari Medical School, 70124 Bari, Italy; (P.L.); (M.P.); (E.M.); (A.B.); (N.S.)
| | - Eleonora Malerba
- Department of Biomedical Sciences and Human Oncology, “Aldo Moro” University of Bari Medical School, 70124 Bari, Italy; (P.L.); (M.P.); (E.M.); (A.B.); (N.S.)
| | - Antonella Bray
- Department of Biomedical Sciences and Human Oncology, “Aldo Moro” University of Bari Medical School, 70124 Bari, Italy; (P.L.); (M.P.); (E.M.); (A.B.); (N.S.)
| | - Nicola Susca
- Department of Biomedical Sciences and Human Oncology, “Aldo Moro” University of Bari Medical School, 70124 Bari, Italy; (P.L.); (M.P.); (E.M.); (A.B.); (N.S.)
| | - Giuseppe Ingravallo
- Section of Pathology, Department of Emergency and Organ Transplantation, “Aldo Moro” University of Bari Medical School, 70124 Bari, Italy;
| | - Vito Racanelli
- Department of Biomedical Sciences and Human Oncology, “Aldo Moro” University of Bari Medical School, 70124 Bari, Italy; (P.L.); (M.P.); (E.M.); (A.B.); (N.S.)
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Zhang H, Zhang L, Guo N. Pediatric-onset systemic lupus erythematosus with coronary artery dilation: A case report. Medicine (Baltimore) 2020; 99:e18946. [PMID: 32000416 PMCID: PMC7004661 DOI: 10.1097/md.0000000000018946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 11/28/2019] [Accepted: 12/30/2019] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Though pediatric-onset systemic lupus erythematosus (SLE) is at high risk of coronary artery involvement, coronary artery dilation appears to be a rare characteristic of pediatric-onset SLE. In this article, we described 1 pediatric-onset SLE patient with coronary artery dilation at the diagnosis of SLE, in order to better diagnose and manage this cardiac complication of SLE in children. PATIENT CONCERNS A 13-year-old boy was admitted in hospital for daily fevers with the highest temperature of 39.2°C over 10 days, with rash, non-exudative conjunctivitis, cervical adenopathy, knee, and ankle arthralgi. The result of echocardiogram implicated coronary artery dilation and aortic regurgitation. Further laboratory tests showed: Coomb's test (+), decreased C3 complement. The results of immunologic tests were only to find ANA (+) with titer 1:3200, ds-DNA (+). DIAGNOSIS This patient was diagnosed as SLE complicated with coronary artery dilation. INTERVENTIONS The patient was treated with intravenous methylprednisolone pulse therapy. He was discharged home on prednisone maintain treatment. OUTCOMES As soon as treatment, his temperature returned to normal, with recovery of rash, conjunctivitis, knee, and ankle arthralgi. However, the echocardiogram of this patient after 3 months also had dilation of left coronary artery (LCA) and right coronary artery (RCA). CONCLUSIONS Cardiac complication can occur during the entire course of SLE, suggesting that routine echocardiogram surveillance may be necessary for all SLE patients to prevent morbidity and mortality from cardiovascular events.
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Affiliation(s)
- Hui Zhang
- The Department of Pediatrics, West China Second University Hospital of Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
| | - Lijuan Zhang
- The Department of Pediatrics, West China Second University Hospital of Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
| | - Nan Guo
- The Ultrasonic Department, West China Second University Hospital of Sichuan University, Chengdu 610041, China
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Nandkeolyar S, Kim HB, Doctorian T, Stoletniy LN, Sandhu VK, Yu M, Zuppan CW, Razzouk A, Hilliard A, Parwani P. A case report of heart transplant for ischaemic cardiomyopathy from lupus coronary vasculitis. EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 3:1-7. [PMID: 32123802 PMCID: PMC7042145 DOI: 10.1093/ehjcr/ytz183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 05/29/2019] [Accepted: 09/25/2019] [Indexed: 11/13/2022]
Abstract
Background Coronary vasculitis is a rare, life-threatening complication of systemic lupus erythematosus (SLE). Case summary A 23-year-old woman with SLE presented with typical angina and worsening dyspnoea on exertion. Coronary angiography revealed severe triple vessel disease with a ‘string of beads’ appearance classic for coronary vasculitis. Transthoracic echocardiogram revealed ejection fraction of 25–30% with a severely hypokinetic distal septum and distal anterior wall and an akinetic apical wall. Despite vasculitis treatment with cyclophosphamide and pulse-dose steroids, her coronary vasculitis did not improve. She was refractory to anti-anginal and guideline-directed medical therapy for heart failure and successfully underwent orthotopic heart transplant (OHT). Discussion This is the first reported case of OHT in the case of SLE coronary vasculitis. Chronic SLE coronary vasculitis is caused by lymphocyic infiltration leading to inflammation and fibrosis of the major epicardial coronary arteries but can be successfully managed with OHT when refractory to medical SLE and heart failure therapies. It can affect patients of all ages with SLE, emphasizing the importance of thorough history taking and clinical evaluation in young patients presenting with cardiac symptoms to establish an appropriate diagnosis and treatment plan.
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Affiliation(s)
- Shuktika Nandkeolyar
- Division of Cardiology, Department of Medicine, Loma Linda University Medical Center, 11234 Anderson St. Room 4404, Loma Linda, CA 92354, USA
| | - Hyungjin B Kim
- Division of Cardiology, Department of Medicine, Loma Linda University Medical Center, 11234 Anderson St. Room 4404, Loma Linda, CA 92354, USA
| | - Tanya Doctorian
- Division of Cardiology, Department of Medicine, Loma Linda University Medical Center, 11234 Anderson St. Room 4404, Loma Linda, CA 92354, USA
| | - Liset N Stoletniy
- Division of Cardiology, Department of Medicine, Loma Linda University Medical Center, 11234 Anderson St. Room 4404, Loma Linda, CA 92354, USA
| | - Vaneet K Sandhu
- Division of Rheumatology, Loma Linda University Medical Center, 11234 Anderson St. Room 3650, Loma Linda, CA 92354, USA
| | - Micah Yu
- Division of Rheumatology, Loma Linda University Medical Center, 11234 Anderson St. Room 3650, Loma Linda, CA 92354, USA
| | - Craig W Zuppan
- Department of Pathology and Human Anatomy, Loma Linda University Medical Center, 11234 Anderson St. Ste 2950, Loma Linda, CA 92354, USA
| | - Anees Razzouk
- Department of Cardiothoracic Surgery, Loma Linda University Medical Center, 11234 Anderson St. Ste 1617, Loma Linda, CA 92354, USA
| | - Anthony Hilliard
- Division of Cardiology, Department of Medicine, Loma Linda University Medical Center, 11234 Anderson St. Room 4404, Loma Linda, CA 92354, USA
| | - Purvi Parwani
- Division of Cardiology, Department of Medicine, Loma Linda University Medical Center, 11234 Anderson St. Room 4404, Loma Linda, CA 92354, USA
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Saling LJ, Raptis DA, Parekh K, Rockefeller TA, Sheybani EF, Bhalla S. Abnormalities of the Coronary Arteries in Children: Looking beyond the Origins. Radiographics 2017; 37:1665-1678. [PMID: 29019754 DOI: 10.1148/rg.2017170018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Coronary arterial abnormalities are uncommon findings in children that have profound clinical implications. Although anomalies of the coronary origins are well described, there are many other disease processes that affect the coronary arteries. Immune system-mediated diseases (eg, Kawasaki disease, polyarteritis nodosa, and other vasculiditides) can result in coronary arterial aneurysms, strictures, and abnormal tapering of the vessels. Because findings at imaging are an important component of diagnosis in these diseases, the radiologist's understanding of them is essential. Congenital anomalies may present at varying ages, and findings in hemodynamically significant anomalies, such as fistulas, are key for both diagnosis and preoperative planning. Pediatric heart surgery can result in wide-ranging postoperative imaging appearances of the coronary arteries and also predisposes patients to a multitude of complications affecting the heart and coronary arteries. In addition, although rare, accidental trauma can lead to injury of the coronary arteries, and awareness and detection of these conditions are important for diagnosis in the acute setting. Patients with coronary arterial conditions at presentation may range from being asymptomatic to having findings of myocardial infarction. Recognition of the imaging findings is essential to direct appropriate treatment. ©RSNA, 2017.
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Affiliation(s)
- Lauren J Saling
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (L.J.S., D.A.R., S.B.); Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, Ill (K.P.); Department of Cardiology, St Louis Children's Hospital, St Louis, Mo (T.A.R.); and Department of Radiology, Mercy Hospital, St Louis, Mo (E.F.S.)
| | - Demetrios A Raptis
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (L.J.S., D.A.R., S.B.); Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, Ill (K.P.); Department of Cardiology, St Louis Children's Hospital, St Louis, Mo (T.A.R.); and Department of Radiology, Mercy Hospital, St Louis, Mo (E.F.S.)
| | - Keyur Parekh
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (L.J.S., D.A.R., S.B.); Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, Ill (K.P.); Department of Cardiology, St Louis Children's Hospital, St Louis, Mo (T.A.R.); and Department of Radiology, Mercy Hospital, St Louis, Mo (E.F.S.)
| | - Toby A Rockefeller
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (L.J.S., D.A.R., S.B.); Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, Ill (K.P.); Department of Cardiology, St Louis Children's Hospital, St Louis, Mo (T.A.R.); and Department of Radiology, Mercy Hospital, St Louis, Mo (E.F.S.)
| | - Elizabeth F Sheybani
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (L.J.S., D.A.R., S.B.); Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, Ill (K.P.); Department of Cardiology, St Louis Children's Hospital, St Louis, Mo (T.A.R.); and Department of Radiology, Mercy Hospital, St Louis, Mo (E.F.S.)
| | - Sanjeev Bhalla
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (L.J.S., D.A.R., S.B.); Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, Ill (K.P.); Department of Cardiology, St Louis Children's Hospital, St Louis, Mo (T.A.R.); and Department of Radiology, Mercy Hospital, St Louis, Mo (E.F.S.)
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Sharma A, Dhooria A, Aggarwal A, Rathi M, Chandran V. Connective Tissue Disorder-Associated Vasculitis. Curr Rheumatol Rep 2017; 18:31. [PMID: 27097818 DOI: 10.1007/s11926-016-0584-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Vasculitides secondary to connective tissue diseases are classified under the category of 'vasculitis associated with systemic disease' in the revised International Chapel Hill Consensus Conference (CHCC) nomenclature. These secondary vasculitides may affect any of the small, medium or large vessels and usually portend a poor prognosis. Any organ system can be involved and the presentation would vary depending upon that involvement. Treatment depends upon the type and severity of presentation. In this review, we describe secondary vasculitis associated with rheumatoid arthritis, systemic lupus erythematosus, sarcoidosis, relapsing polychondritis, systemic sclerosis, Sjogren's syndrome and idiopathic inflammatory myositis, focusing mainly on recent advances in the past 3 years.
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Affiliation(s)
- Aman Sharma
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India, 160012.
| | - Aadhaar Dhooria
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India, 160012
| | - Ashish Aggarwal
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India, 160012
| | - Manish Rathi
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vinod Chandran
- Department of Medicine, Division of Rheumatology, & Division of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network, Toronto, ON, Canada
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Agarwal A, Medical student SB, Lim-Stavros S, Votava-Smith JK, Ramanathan A. Pediatric systemic lupus erythematosus presenting with coronary arteritis: A case series and review of the literature. Semin Arthritis Rheum 2015; 45:42-7. [DOI: 10.1016/j.semarthrit.2015.02.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 02/26/2015] [Accepted: 02/27/2015] [Indexed: 02/08/2023]
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