Zlatkin S, Aamar S, Specter G, Leibowitz D, Simanovsky N, Yeshurun D, Heyman S N
Department of Medicine, Hadassah University Hospital, Mt. Scopus, Jerusalem, Israel.
Isr Med Assoc J. 1999 Dec;1(4):245-9.
Takayasu's arteritis is a rare, probably underdiagnosed disorder in Israel.
To evaluate the contribution of computerized tomography to the diagnosis of Takayasu's arteritis.
A retrospective analysis of the diagnostic process was recently conducted in three consecutive patients diagnosed over the last 3 years.
Three females of Arab origin with Takayasu's arteritis were recently identified by CT. In two of the three patients the imaging procedure was performed for different working hypotheses, and the radiological findings (wall thickening, perivascular edema, and segmental intraluminal obliteration of the aorta and its major branches) were unexpected. In these two patients, repeated physical examination following the imaging procedure disclosed initially missed findings that could have led to an earlier consideration of Takayasu's arteritis (bruits above the epigastrium, subclavian and carotid arteries, and absent brachial pulses). Retrospective analysis of the patients' symptoms following CT revealed the true nature of the patients misinterpreted complaints (e.g., typical abdominal angina replaced a faulty obtained history compatible with renal colic or dyspepsia). In the third patient CT was performed for the evaluation of an epigastric bruit associated with constitutional complaints. The diagnosis of aortitis, based upon the presence of diffuse aortic wall thickening and edema of the surrounding fat, without intraluminal narrowing, could have been missed by angiography, the traditional "gold standard" diagnostic procedure. All three patients complained of ill-defined epigastric abdominal pain and had epigastric tenderness during examination.
CT has the potential for detecting Takayasu's disease and may be superior to angiography, particularly at the early non-obliterative stage. Since the diagnosis of Takayasu's disease is rarely considered, the expanding use of CT and MRI technologies may reveal missed cases that are evaluated for other plausible diagnoses. The true incidence of Takayasu's arteritis in Israel may be much higher than reported, particularly in the Arab population. Our findings suggest that epigastric tenderness, originating from active inflammatory reaction in the abdominal aortic wall, should be considered as a diagnostic criterion of Takayasu's aortitis.
高安动脉炎在以色列是一种罕见的、可能未被充分诊断的疾病。
评估计算机断层扫描对高安动脉炎诊断的贡献。
最近对过去3年连续诊断的3例患者的诊断过程进行了回顾性分析。
最近通过CT识别出3例患有高安动脉炎的阿拉伯裔女性。在这3例患者中的2例中，进行成像检查是基于不同的工作假设，而放射学表现（主动脉及其主要分支的管壁增厚、血管周围水肿和节段性管腔内闭塞）是出乎意料的。在这2例患者中，成像检查后反复进行体格检查发现了最初遗漏的体征，这些体征本可促使更早考虑高安动脉炎（上腹部、锁骨下动脉和颈动脉上方有杂音，肱动脉搏动消失）。对CT检查后患者症状的回顾性分析揭示了对患者主诉的错误解读的真实性质（例如，典型的腹部绞痛替代了与肾绞痛或消化不良相符的错误病史）。在第3例患者中，进行CT检查是为了评估与全身不适相关的上腹部杂音。基于弥漫性主动脉壁增厚和周围脂肪水肿而无管腔内狭窄的主动脉炎诊断，可能会被传统的“金标准”诊断方法血管造影遗漏。所有3例患者均主诉上腹部疼痛不明确，检查时上腹部有压痛。
CT有检测高安病的潜力，可能优于血管造影，尤其是在早期非闭塞阶段。由于很少考虑高安病的诊断，CT和MRI技术的广泛应用可能会发现因评估其他合理诊断而遗漏的病例。高安动脉炎在以色列的真实发病率可能远高于报道的数字，尤其是在阿拉伯人群中。我们的研究结果表明，源于腹主动脉壁活动性炎症反应的上腹部压痛应被视为高安主动脉炎的诊断标准。
