Vasculitis-large vessel occlusion-CT angiography

Case contributed by Dr Dalia Ibrahim

Presentation

Right upper limb pain and numbness. History of autoimmune disease and arteritis.

Patient Data

Age: 45 years
Gender: Female

CT angiography of the right upper extremity arterial system showed:

  • Normal appearance of the subclavian artery with no stenotic or occlusive lesions

  • Occluded distal axillary and proximal segment of the brachial arteries as well as the anterior circumflex artery, with collateral refilling the brachial artery via the posterior circumflex artery

  • Patent radial artery which could be traced down to the wrist with attenuated non-opacified distal segment

  • Patent mildly attenuated ulnar artery with non opaicfied distal segment.

  • Patent common interossous, anterior and posterior inter-osseous arteries with attenuated non opacified their distal segments

 

Case Discussion

Vasculitis represents an inflammatory process of the blood vessels. The most common types of vasculitis which affect the upper extremity include Takayasu arteritis, giant cell arteritis, and thromboangiitis obliterans. CTA can non-invasively diagnose vasculitis of large and medium arteries.

Vasculitis usually shows a long segment of stenosis with gentle tapering, in contrast to atherosclerosis in which there are focal stenosis and abrupt occlusion. Vessel wall thickening and enhancement are also characteristic signs of vasculitis and indicates an active phase of the disease.

Special thanks to Dr. Mohamed Ibrahim, Consultant of general radiology, Kasr Al Ainy Hospital

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