Temporal (Giant Cell) Arteritis
large vessel vasculitis. most common form of vasculitis in older adults, pts > 50, usually females.
Temporal (Giant Cell) Arteritis Pathology
- a granulomatous vasculitis with giant cells.
- intimal fibrosis (healing of chronic inflammation)
Biopsy of Temporal (Giant Cell) Arteritis
Long piece needed for biopsy due to ‘skip lesions’.
Temporal (Giant Cell) Arteritis Treatment
Granulomatous vasculitis, large vessel vasculitis
Pts usually less than age of 50
- classic pt is young asian female.
Involves the aortic arch at branch points
Visual and neurologic symptoms
Weak or absent pulses in the upper extremity.
Treatment is corticosteroids
Medium Vessel Vasculitis
- involves muscular arteries, supply organs
medium vessel vasculitis, necrotizing Vasculitis that involves most organs, but the lungs are spared.
Polyarteritis Nodosa - Signs and Symptoms
- HTN (renal artery involvement)
- Abdominal pain and melena (mesenteric artery)
- Neruologic disturbances
- Skin lesions
- -> Associated with serum HepB surface antigen???
Polyarteritis Nodosa classical finding on imaging
String of pearls appearance.
Polyarteritis Nodosa Histology
fibrinoid necrosis - highlighter pink color of vessel wall.
Polyarteritis Nodosa treatment
corticosteroid or cyclophosphamide
Kawasaki Disease - Clinical Presentation
rash of the palms and soles
enlarged cervical lymph nodes
Kawasaki Disease Vessels involved
Involves coronary artery, medium vessel vasculitis
Kawasaki Disease Vessels Involved
Aspirin - one of the only situations in which you would give a child aspirin.
Medium vessel vasculitis of the fingers and toes strong association with smoking.
Disease leads to ulceration of fingers and toes, autoamputation.
Cessation of smoking terminates disease.
Raynaud phenomenon is often present.
Small vessel vasculitis. Necrotizing granulomatous disease involving the nasopharynx, lungs, and kidneys.
Wegener Granulomatosis - clinical presentation
Middle aged males
sinusitis, nasopharyngeal ulceration
hematuria due to RPGN
C-ANCA levels correlates with disease activity.
Small vessel vasculitis. Necrotizing vasculitis involves the lung and kidney
- distinct from wegeners in that you will not see necrotizing granuloma. You also will not see nasopharyngeal involvement.
Necrotizing granulomatous vasculitis with eosinophils.
- Asthma and peripheral eosinophilia.
Henoch Schonlein Purpura - HSP
Vasculitis due to IgA immune complex deposition.
palpable purpura on the buttocks and the legs.
inflammation makes the purpura palpable.
can get GI pain and bleeding
can get hemturia (IgA nephropathy)
– occurs following an upper respiratory tract infection.
Henoch Schonlein Purpura - HSP treatment
self limited, if severe can consider treatment with steroids.
Arteriosclerosis - types
Atherosclerosis - intimal plaque, involving medium and large vessels
Arteriolosclerosis - narrowing of the small vessels either deposition of protein in the wall (hyaline) or hyperplasia of smooth of the wall.
Monkeberg medial calcific sclerosis (not as clinically significant)
intimal plaque. consists of necrotic lipid core in the intima with fibromuscular cap. obstructs blood flow in the vessel.