Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3774_Библиотеки_им_академика_М_И_Перельмана

rst- line imaging modality for predominantly cranial GCA in centres where experi­ence is at hand, as the test is non-invasive, immediate and cost effective, and in some centres, is replacing the need for TAB [7]. The temporal artery ultrasound nding of a non-compressible halo sign, caused by oedema of the vessel wall, has a reported sensitivity between 77 and 79% and specicity between 96 and 100% for the diag­nosis of GCA. This investigation is dependent on training and expertise of the sonographer, however, and the ability to detect a halo sign declines rapidly after the initiation of glucocorticoids, with sensitivity falling to below 50% at 4days. For conrmation of large vessel GCA not involving cranial vessels, other imaging tech­niques are required, which are also sensitive to glucocorticoid therapy. High­resolution MRI has the advantages of the absence of radiation, the contemporaneous detection of structural lesions (such as vessel wall thickening and luminal stenosis/ occlusion), and contrast enhancement of the arterial wall presumed (but not proven) to reect active inammation [7]. Compared with TAB, 18F-uorodeoxyglucose PET combined with low dose ne cut computed tomography (18F-FDG-PET/CT) performed within 72h of commencement of glucocorticoids had a sensitivity of 92%, specicity of 85%, negative predictive value of 98%, and identied patients with aortitis, who require closer follow up for late complications such as aneurysm development or aortic regurgitation. Cranial arteritis affects temporal, vertebral, maxillary and occipital arteries, with vasculitis mimics including malignancies found in 20% of patients [8].

Stenting of arterial stenoses, particularly of renal arteries is often required, prefer­ably when vessel inammation has been controlled. Collateral circulation may compensate and improve painful limb claudication over time. In both TAK and GCA, the late complications of aortic root dilatation with aneurysm formation and/ or aortic valve regurgitation, or abdominal aortic aneurysm, may require surgical intervention. In patients with large vessel vasculitis (GCA or TAK), MRA, CT angi­ography (CTA) and/or ultrasound may be used for long-term monitoring of struc­tural damage, particularly to detect stenosis, occlusion, dilatation and/or aneurysms. The frequency of screening as well as the imaging method applied should be decided on an individual basis [

Kawasaki disease (KD) is a paediatric vasculitis with coronary artery aneurysms (CAA) as its main complication. It is most common in Japan and Asia, with reported incidence rates of 265/100,000, most patients being between 6months and 5years of age. The male:female ratio is approximately 1.5:1 [17].

This syndrome is characterized by eosinophil-rich granulomatous inammation of the airways along with small- and medium-vessel vasculitis. Three different dis­ease phases are usually described, namely, prodromal, eosinophilic, and vasculitic. The main clinical feature in the prodromal stage is asthma (which may predate vasculitis by years) and allergic rhinitis with or without polyposis. Upper airway involvement is much milder than in GPA.The second phase is of peripheral and tissue eosinophilia, which may be masked by glucocorticoid use for asthma. Vasculitic manifestations occur in nerves, heart, lungs, GI tract, and kidneys. Skin involvement is a dominant feature in the form of nodules; urticaria or ulceration. Neurologic involvement occurs in 60–70% of patients in the form of multiple mononeuropathies or symmetric polyneuropathy; ischemic optic neuropathy, cra­nial neuropathies, and stroke are less common. Cardiac involvement is seen in up to 20% of patients in the form of myocarditis, pericarditis, endocarditis, valvulitis, and coronary vasculitis, and contributes to half the deaths. Renal involvement in the form of small vessel vasculitis is less common than other AAVs [22].