Crain Matthew A, Lakhani Dhairya A, Winkler Lana, Adelanwa Ayodele, Kim Cathy
West Virginia University School of Medicine, Morgantown, WV.
Department of Radiology, West Virginia University, 1 Medical Center Drive, Morgantown, WV, 26506.
Radiol Case Rep. 2021 Oct 2;16(12):3734-3738. doi: 10.1016/j.radcr.2021.08.072. eCollection 2021 Dec.
Giant cell arteritis, the most common form of vasculitis in the elderly, is characterized by granulomatous inflammation of arteries, which can lead to serious, life-threatening conditions including aortic aneurysms, ruptures, and dissections as well as blindness. Since GCA can be treated by immunosuppressant therapy, such as corticosteroids, early diagnosis and treatment may reduce the risk of serious disability and morbidity. While temporal artery biopsy is considered the gold standard to diagnosis giant cell arteritis, it is intrusive with inherent risks as well as unreliable due to tissue sampling. Imaging studies, such as computerized tomography, are nonintrusive and have been shown to identify vasculitis including giant cell arteritis. We present a case of a 72-year-old male patient who was diagnosed with giant cell arteritis by temporal artery biopsy during surgery for aortic aneurysm and coronary artery bypass graft. Computerized tomography imaging studies, prior to the surgery and biopsy, were suggestive of vasculitis. This case serves to emphasize the beneficial role of imaging studies to assess vasculitis, including giant cell arteritis, that can be done prior to the progressive development of more serious debilitating and potentially fatal pathology.
巨细胞动脉炎是老年人中最常见的血管炎形式,其特征是动脉的肉芽肿性炎症,可导致严重的、危及生命的情况,包括主动脉瘤、破裂和夹层以及失明。由于巨细胞动脉炎可通过免疫抑制疗法(如皮质类固醇)进行治疗,早期诊断和治疗可能会降低严重残疾和发病的风险。虽然颞动脉活检被认为是诊断巨细胞动脉炎的金标准,但它具有侵入性,存在固有风险,并且由于组织采样而不可靠。成像研究,如计算机断层扫描,是非侵入性的,并且已被证明可识别包括巨细胞动脉炎在内的血管炎。我们报告一例72岁男性患者,他在接受主动脉瘤手术和冠状动脉搭桥术期间通过颞动脉活检被诊断为巨细胞动脉炎。在手术和活检之前的计算机断层扫描成像研究提示存在血管炎。该病例旨在强调成像研究在评估血管炎(包括巨细胞动脉炎)方面的有益作用,这种评估可以在更严重的致残性和潜在致命性病理状况逐渐发展之前进行。