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Kong X, Zhang J, Lin J, Lv P, Chen H, Ji Z, Dai X, Jin X, Ma L, Jiang L. Pulmonary findings on high-resolution computed tomography in Takayasu arteritis. Rheumatology (Oxford) 2021; 60:5659-5667. [PMID: 33590834 DOI: 10.1093/rheumatology/keab163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 02/10/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE This study aimed to describe pulmonary high-resolution CT (HRCT) findings in Takayasu arteritis (TA) and to determine possible causes. METHODS A total of 243 TA patients were enrolled from a prospective cohort after excluding patients with other pulmonary disorders or incomplete data. Patients were divided into two groups: those with normal lung HRCT and those with abnormal lung HRCT. Clinical characteristics were compared between groups and binary logistic regression analysis was applied to identify possible causes of the lung lesions. Follow-up HRCT (obtained in 64 patients) was analysed to study changes in pulmonary lesions after treatment. RESULTS Of the 243 patients, 107 (44.0%) had normal lung HRCT while 136 (56.0%) had abnormal lung HRCT, including stripe opacity (60.3%), nodules (44.9%), patchy opacity (25.0%), pleural thickening (15.4%), pleural effusion (10.3%), ground-glass opacity (8.1%), pulmonary infarction (6.6%), mosaic attenuation (4.4%), bronchiectasis (3.7%) and pulmonary oedema (2.2%). Patients with abnormal HRCT were significantly more likely to have type II arterial involvement (25% vs 12.2%, P = 0.04), pulmonary arterial involvement (PAI; 21.3% vs 5.6%, P < 0.001), pulmonary hypertension (20.6% vs 8.4%, P = 0.01) and abnormal heart function (27.9% vs 7.6%, P < 0.001). Logistic regression analysis demonstrated that PAI, worsened heart function and age were associated with presence of pulmonary lesions. Pulmonary infarction, pleural effusion and patchy opacities improved partially after treatment. CONCLUSION Pulmonary lesions are not rare in patients with TA. Age, PAI and worsened heart function are potential risk factors for presence of pulmonary lesions in TA.
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Affiliation(s)
| | | | | | | | | | | | | | - Xuejuan Jin
- Department of Clinical Epidemiology Center, Zhongshan Hospital.,Center of Clinical Epidemiology and Evidence-based Medicine, Fudan University, Shanghai, China
| | - Lili Ma
- Department of Rheumatology.,Center of Clinical Epidemiology and Evidence-based Medicine, Fudan University, Shanghai, China
| | - Lindi Jiang
- Department of Rheumatology.,Center of Clinical Epidemiology and Evidence-based Medicine, Fudan University, Shanghai, China
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Kamada H, Ota H, Aoki T, Sugimura K, Yaoita N, Shimokawa H, Takase K. 4D-flow MRI assessment of blood flow before and after endovascular intervention in a patient with pulmonary hypertension due to isolated pulmonary artery involvement in large vessel vasculitis. Radiol Case Rep 2020; 15:190-194. [PMID: 31890066 PMCID: PMC6928274 DOI: 10.1016/j.radcr.2019.11.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 11/24/2019] [Indexed: 12/03/2022] Open
Abstract
A 43-year-old woman presented with dyspnea during exertion and lower leg edema. Contrast-enhanced computed tomography images demonstrated extensive proximal narrowing in the right main pulmonary artery with thickening and enhancement. Right heart catheterization revealed the presence of precapillary pulmonary hypertension with a mean pulmonary arterial pressure of 45 mm Hg. The patient was diagnosed with large-vessel vasculitis with isolated pulmonary artery involvement. Takayasu's arteritis was suspected, but histological examination was not performed. Several sessions of pulmonary arterial intervention were stratified for the right main pulmonary artery. After treatment, mean pulmonary arterial pressure had decreased to 22 mm Hg with improvement in symptoms. Thoracic 4D-flow magnetic resonance imaging was performed before and after intervention to evaluate the volume flow rates of pulmonary arteries. The rates increased at the inlet of the right pulmonary artery (before: 23 mL/s vs after: 47.5 mL/s) and the main pulmonary artery (before: 71.2 mL/s vs after: 82.5 mL/s), and decreased at the inlet of the left pulmonary artery (before: 46.2 mL/s vs after: 31.7 mL/s). The split ratio of volume flow rate between the right and left pulmonary arteries improved after treatment (before. right:left = 33.1:66.9; after, right:left = 60.0:40.0), approaching normal values. This report quantitatively describes perioperative hemodynamic changes in a patient with pulmonary hypertension using 4D-flow magnetic resonance imaging. Stent placement for stenosis in the right pulmonary artery resulted in an increase in overall pulmonary blood flow and also improved blood flow balance between the right and the left pulmonary arteries.
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Affiliation(s)
- Hiroki Kamada
- Department of Diagnostic Radiology, Tohoku University Hospital, Tohoku University Hospital, 1-1, Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Hospital, Tohoku University Hospital, 1-1, Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Tatsuo Aoki
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Koichiro Sugimura
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Nobuhiro Yaoita
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Hospital, Tohoku University Hospital, 1-1, Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
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Perrotta S, Rådberg G, Perrotta A, Lentini S. Aneurysmatic disease in patients with Takayasu disease: a case review. Herz 2011; 37:347-53. [DOI: 10.1007/s00059-011-3543-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Accepted: 09/29/2011] [Indexed: 10/15/2022]
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Qin L, Hong‐Liang Z, Zhi‐Hong L, Chang‐Ming X, Xin‐Hai N. Percutaneous transluminal angioplasty and stenting for pulmonary stenosis due to Takayasu's arteritis: clinical outcome and four-year follow-up. Clin Cardiol 2009; 32:639-43. [PMID: 19938051 PMCID: PMC6653073 DOI: 10.1002/clc.20665] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Accepted: 07/14/2009] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Percutaneous transluminal angioplasty and stent implantation for stenotic lesions of renal arteries and other branches of the aorta in Takayasu's arteritis have been reported to show good outcomes. However, this form of therapy has been reported in few cases with pulmonary artery involvement. HYPOTHESIS The aim of this study was to evaluate the role of this interventional treatment for pulmonary stenosis due to Takayasu's arteritis. METHODS A total of 4 patients (3 female and 1 male, ages 30-40 yrs) with Takayasu's pulmonary arteritis underwent percutaneous transluminal balloon angioplasty and stent implantation and were followed up for 1 to 4 years. RESULTS One patient underwent balloon angioplasty alone, 3 patients underwent balloon angioplasty and stent implantation. The stenoses were relieved acutely, oxygen saturation improved immediately due to improvement in lung perfusion and relief of dyspnea. The pressure gradient fell from 58.3 +/- 8.7 mm Hg to 14 +/- 3.2 mm Hg and mean pulmonary arterial pressure decreased from 48.5 +/- 12.0 mm Hg to 37.3 +/- 6.0 mm Hg. At a follow-up period of 34.5 +/- 15.8 months, the patient with balloon angioplasty alone developed a recurrence of symptoms 18 months after the procedure. The other 3 patients continued to be asymptomatic and the stent remained patent without restenosis after the procedure. CONCLUSION Percutaneous transluminal angioplasty and stent implantation is a safe and effective treatment in patients with pulmonary stenosis caused by Takayasu's arteritis.
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Affiliation(s)
- Luo Qin
- Center for Pulmonary Vascular Disease, Fuwai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Zhang Hong‐Liang
- Center for Pulmonary Vascular Disease, Fuwai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Liu Zhi‐Hong
- Center for Pulmonary Vascular Disease, Fuwai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Xiong Chang‐Ming
- Center for Pulmonary Vascular Disease, Fuwai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Ni Xin‐Hai
- Center for Pulmonary Vascular Disease, Fuwai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences and Peking Union Medical College
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Affiliation(s)
- Nobuyuki Nakajima
- Professor Emeritus from Chiba University Graduate School of Medicine, Chiba, Japan
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Canyigit M, Peynircioglu B, Hazirolan T, Dagoglu MG, Cil BE, Haliloglu M, Balkanci F, Besim A. Imaging characteristics of Takayasu arteritis. Cardiovasc Intervent Radiol 2007; 30:711-8. [PMID: 17533545 DOI: 10.1007/s00270-007-9050-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Takayasu arteritis is a rare, large-vessel vasculitis in which the nonspecific systemic inflammatory symptoms are followed by inflammation of the aorta and its major branches. The inflammation of this vessel leads to progressive luminal stenosis or aneurysm formation resulting in limb or organ ischemia. Although conventional angiography is still accepted as the gold standard modality, the information obtained is limited to the vessel lumen. Multidetector computed tomographic angiography and magnetic resonance angiography can provide valuable information not only regarding intraluminal pathologies but also concerning the thickening of the vessel wall, which may be the earliest manifestation of the disease.
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Affiliation(s)
- Murat Canyigit
- Department of Radiology, Faculty of Medicine, Hacettepe University, Sihhiye, 06100, Ankara, Turkey.
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Nakamura T, Hayashi S, Fukuoka M, Sueoka N, Nagasawa K. Pulmonary infarction as the initial manifestation of Takayasu's arteritis. Intern Med 2006; 45:725-8. [PMID: 16819253 DOI: 10.2169/internalmedicine.45.1686] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 50-year-old woman reporting sudden-onset chest pain was diagnosed as having pulmonary infarction associated with Takayasus arteritis. She had experienced moderate malaise and cough for 3 months. Computed tomography (CT) and magnetic resonance imaging (MRI) showed wedge-shaped infiltrative shadows typical of pulmonary infarction in the right lung. Although pulmonary artery involvement in Takayasus arteritis is well documented, most patients show only signs of mild to moderate pulmonary hypertension. Few reports discuss patients with symptoms due to pulmonary infarction as the initial manifestation. Takayasus arteritis should therefore be considered a differential diagnosis in pulmonary infarction.
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Affiliation(s)
- Tomomi Nakamura
- Division of Pulmonary, Department of Medicine, Saga University Medical School, Nabeshima
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Andreu J, Hidalgo A, Pallisa E, Majó J, Martinez-Rodriguez M, Cáceres J. Septal thickening: HRCT findings and differential diagnosis. Curr Probl Diagn Radiol 2004; 33:226-37. [PMID: 15459632 DOI: 10.1067/j.cpradiol.2004.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Thickening of the interlobular septa is a common and easily recognized high-resolution computed tomography feature of many diffuse lung diseases. In some cases, it is the predominant radiological finding. This article reviews the spectrum of entities that commonly present with thickening of the interlobular septa as the main radiological feature and establishes a practical approach for the differential diagnosis.
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Affiliation(s)
- J Andreu
- Department of Radiology, HGU Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
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Neidhart B, Kosek R, Bachmann LM, Stey C. Exertional dyspnea as initial manifestation of Takayasu's arteritis--a case report and literature review. BMC Pulm Med 2001; 1:3. [PMID: 11801196 PMCID: PMC64544 DOI: 10.1186/1471-2466-1-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2001] [Accepted: 12/18/2001] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Takayasu's arteritis is a chronic systemic inflammatory disease that usually affects the aorta, its primary branches and occasionally the pulmonary and coronary arteries. Female gender in reproductive age and Asian origin are known factors associated with higher disease prevalence. The clinical manifestations vary considerably and are typically caused by limb or organ ischemia illness and fever. The estimated incidence rate in the western world is 2.6 cases per million persons per year. Occasionally, exertional dyspnea can be the sole primary clinical manifestation of Takayasu's arteritis. CASE PRESENTATION We report the case of a 57-year-old woman who was referred to our institution with increasing exertional dyspnea caused by pulmonary artery involvement in Takayasu's arteritis. In a review of the literature we discuss demographic data, clinical and radiographic findings and available therapeutic options. CONCLUSIONS Dyspnea due to pulmonary artery involvement can be the initial symptom of Takayasu's arteritis. Simple clinical tests, including a complete pulse-status and blood pressure measuring at both arms can lead to the right diagnosis and should always be done beyond the auscultation of the heart and lungs in patients with dyspnea.
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Affiliation(s)
- Beatrice Neidhart
- Department of Internal Medicine, Medical Policlinic, University Hospital Zurich, Switzerland
| | - Robert Kosek
- Department of Internal Medicine, Medical Policlinic, University Hospital Zurich, Switzerland
| | | | - Claudia Stey
- Department of Internal Medicine, Medical Policlinic, University Hospital Zurich, Switzerland
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Singh J, Brasington RD. Pulmonary Takayasu’s Arteritis Masquerading as Acute Pulmonary Embolism. J Clin Rheumatol 2001; 7:388-94. [PMID: 17039181 DOI: 10.1097/00124743-200112000-00008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Pulmonary involvement may sometimes be the initial presentation of Takayasu's arteritis (TA). Since the signs and symptoms of pulmonary TA may be subtle and may not be easily distinguishable from other pulmonary diseases, one has to maintain a high index of suspicion. Cases of pulmonary TA mimicking chronic thromboembolism have been reported. We describe a patient with TA whose initial presentation mimicked acute pulmonary embolism. The patient presented with a 3-day history of cough and shortness of breath and had multiple bilateral perfusion defects on ventilation-perfusion scan, typical of acute pulmonary embolism. However, the constellation of clinical features, elevated erythrocyte sedimentation rate and the angiographic appearance helped us establish the correct diagnosis of pulmonary Takayasu's arteritis. At a 6-year follow-up, the patient had no worsening of pulmonary symptoms but presented with postural dizziness with angiographic evidence of carotid and innominate artery stenosis; she underwent arterial bypass grafting. In young women presenting with a clinical picture of acute pulmonary embolism without the previous history (or risk factors) of thromboembolism, pulmonary TA must be considered in the differential diagnosis.
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Affiliation(s)
- J Singh
- Washington University School of Medicine, Division of Rheumatology, St. Louis, Missouri 63110, USA
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Abstract
INTRODUCTION Vasculitides can be classified according to the size of the involved vessels. The pathological patterns of large vessel vasculitides are presented here. CURRENT KNOWLEDGE AND KEY POINTS They concern Buerger's disease, temporal arteritis, Takayasu's disease, Behçet's disease, infectious arteritides, rheumatologic and miscellaneous diseases. Buerger's disease is a thrombotic arteriopathy with no arterial wall involvement. Temporal arteritis and Takayasu's disease belong to the group of giant cell arteritides. In temporal arteritis, the inflammation is prominent in the internal part of the media and is aggressive for the arterial wall. In Takayasu's disease, the external part of the media is prominently involved. The fibrous thickening of the arterial wall with stenosis is characteristic. Behçet's disease can involve the large arteries with a risk of arterial rupture. Infectious arteritides are not unfrequent in vascular surgery and in previous arterial lesions. Rheumatologic diseases can result in aortitis with aortic incompetence. FUTURE PROSPECTS AND PROJECTS These diseases have pathological characteristics which contribute to diagnosis. However, a clearcut classification of vasculitides will come from the precise knowledge of their etiology.
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Affiliation(s)
- P Bruneval
- Service d'anatomie pathologique, Hôpital Broussais, Paris, France
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