IS Case 276: Vasculitis
Imaging Sciences URMC 2009
Publication Date: 2009-08-05
History
Patient is an 36-year-old male with history of pain and numbness in the right hand.
Findings
Severe narrowing of the ulnar artery at the level of the wrist with incomplete palmar arch formation. There is also severe narrowing of multiple digital arteries.
Diagnosis
Discussion
Vasculitis is a general term that refers to inflammation of blood vessels. When blood vessels become inflamed, they may become weakened, stretch and either increase in size or become narrow.
Vasculitis of the hand and digits is often associated with collagen vascular diseases and cutaneous disorders. Connective tissue diseases often demonstrate multiple stenosis and occlusions of medium to small arteries in the extremities, particularly the hands. Peripheral arteries of the hands are often affected with sparing of forearm and upper arm vessels. In particular, Systemic lupus erythematosus (SLE) and scleroderma can cause vasculitis which on angiography will demonstrate focal occlusions and irregular stenosis of palmar and digital arteries.
Initial imaging for vasculitis begins with CT or MR to evaluate wall thickening with or without enhancement, areas of stenoses, and aneurysms. However, in most instances angiography is needed to evaluate vasculitis associated with collagen vascular disease in order to exclude atherosclerotic or embolic causes.
Patients with vasculitis secondary to collagen vascular diseases often present with digital ischemia and ulcerations. Laboratory work-up includes ESR, rheumatoid factor, ANCA titers, and Hepatitis B and C titers.
Treatment varies with the disease process. Medical management includes NSAIDS, steroids, and even for severe disease cytotoxic drugs such as azathioprine and cyclophorphamide. Surgery is an options in those patients whose symptoms are refractory to medical treatment.
References
- Valji K. Vascular and Interventional Radiology. 2nd Ed., Saunders, 2006.
- Baum S, Pentecost Ml, Editors. Abrams' Angiography: Interventional Radiology. 2nd Ed., Lippincott Williams & Wilkins, 2005.
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