Use of Ultrasound in the Diagnosis and Management of the Vasculitides
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VASCULITIS (L ESPINOZA, SECTION EDITOR)
Use of Ultrasound in the Diagnosis and Management of the Vasculitides Dasha Lopez 1 & Myriam Guevara 2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review The aim of this review paper is to evaluate the current data regarding clinical use of ultrasound (US) for diagnosis of systemic vasculitis. Recent Findings In recent years, US has emerged as an image modality taking a central role in the diagnosis and monitoring of vasculitides by measuring vessel wall inflammation and changes in vessel wall thickness. US has been recognized as an important tool predominantly in the diagnosis of large vessel vasculitis (LVV). Signs like the “halo sign” in temporal arteries of patients with giant cell arteritis (GCA) have demonstrated to be a robust marker. In other types of vasculitides the role of US is not well defined yet but could be of help by diagnosing secondary findings when there is organ involvement, like interstitial lung disease in small vessel vasculitis (SVV). Summary Different modes of ultrasound (US) are being studied for this purpose, especially since it is a non-invasive technique that can limit exposure to ionizing radiation. In conclusion there is clear evidence for the use of US particularly color duplex US (CDS) in the diagnosis of LVV like GCA and Takayasu’s arteritis (TAK). Nevertheless, there is urgent need for more data in regard to the use of US in small/medium vessel vasculitis, as well as the role of US in monitoring of patients with LVV. Keywords Ultrasound . Systemic vasculitis . Color duplex ultrasound . Diagnostic modality . Vessel wall edema . Intima media thickness
Introduction Vasculitis refers to a group of disorders characterized by the presence of inflammatory cells in the walls of blood vessels, which can lead to mural damage and subsequent tissue ischemia and necrosis. Vasculitis can occur as a primary process or secondary to another etiology. It can also vary in type of vessel affected, preferred organ distribution, and clinical manifestations. For the purpose of this review we will focus on noninfectious vasculitides.
This article is part of the Topical Collection on Vasculitis * Myriam Guevara [email protected] 1
Internal Medicine Residency Program, Baton Rouge General Hospital, Baton Rouge, LA, USA
2
Department of Rheumatology, School of Medicine, Louisiana State University, New Orleans, LA, USA
The international Chapel Hill Consensus Conference (CHCC) initially proposed a nomenclature system in 1994 that was later revised in 2012 [1] which categorizes vasculitis based on size of vessel affected, along with structural and functional attributes of the pathology. There are three main categories contemplated in this classification: &
SVV affects intraparenchymal arteries, arterioles, capillaries, venules, and veins; SVV is divided further into antineutrophilic cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and immune complex SVV [2]. AAV is then subdivided into granulomatosis with polya
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