ABSTRACT
La calcifilaxis se caracteriza por una intensa deposición de calcio en pequeños vasos sanguíneos, piel y otros órganos, descripta principalmente en pacientes con insuficiencia renal crónica, trasplante renal o disfunción paratiroidea. Hasta la fecha, solo hay siete casos descriptos en la literatura de calcifilaxis que imita arteritis de células gigantes (ACG). En esta revisión presentamos el octavo caso documentado patológicamente.
Calciphylaxis is characterized by intense deposition of calcium in small blood vessels, skin, and other organs, described mainly in patients with chronic renal insufficiency, renal transplant of parathyroid dysfunction. To date, there are only seven cases described in literature of calciphylaxis mimicking giant cell arteritis (GCA). In this review, we present the eighth case pathologically documented.
Subject(s)
Humans , Male , Middle Aged , Temporal Arteries/pathology , Giant Cell Arteritis/diagnosis , Calciphylaxis/diagnosis , Calciphylaxis/pathology , Diagnosis, DifferentialABSTRACT
Resumen: La arteritis de células gigantes es una vasculitis sistémica frecuente, especialmente en mayores de 50 años. Ante la sospecha clínica el diagnóstico debe ser confirmado con histología o estudios de imágenes. La biopsia de arteria temporal se considera el gold standard, sin embargo, tiene sus limitaciones, una de ellas es la alta tasa de falsos negativos. El estudio por ecotomografía Doppler permite la visualización de las arterias temporales y en manos experimentadas puede constituir un procedimiento diagnóstico alternativo a la biopsia en el estudio inicial de esta entidad. Esta técnica es de fácil acceso, bajo costo, sin riesgos y no expone al paciente a radiación ionizante. En este trabajo revisamos la utilidad clínica de la ecotomografía Doppler en el estudio de la arteria temporal y sus hallazgos imagenológicos en la aproximación diagnóstica a la arteritis de células gigantes, siendo las características de compromiso el engrosamiento parietal arterial hipoecogénico, habitualmente concéntrico, no compresible.
Abstract: Giant cell arteritis is a frequent systemic vasculitis, especially in patients older than 50 years old. When clinically suspected, the diagnosis should be made on the basis of histology or imaging methods. Temporal artery biopsy is considered the gold standard for the diagnosis but it has some caveats, especially the existence of false negatives. Doppler ultrasound study is a low cost, accessible tool that allows visualization of temporal arteries and, in experienced hands, can replace the biopsy in the initial evaluation of the disease, without the risks of ionizing radiation. In this article we review the clinical utility of the temporal artery Doppler ultrasound and its findings in the diagnostic approach of giant cell arteritis, being characteristic a non-compressible, hypoechoic, most commonly concentric arterial wall thickening.
Subject(s)
Humans , Female , Aged , Giant Cell Arteritis/diagnostic imaging , Signs and Symptoms , Temporal Arteries/pathology , Temporal Arteries/diagnostic imaging , Giant Cell Arteritis/pathology , Giant Cell Arteritis/therapy , Ultrasonography, DopplerABSTRACT
Large vessel vasculitis and particularly Temporal Arteritis are systemic diseases that may affect the aorta and its major branches, mainly involving extra cranial branches of the carotid artery. We report a 72-year-old man presenting with weight loss, fever and malaise. Positron emission computed tomography (PET CT) showed an extensive inflammation of the aorta and its major branches. Temporal artery biopsy confirmed the presence of vasculitis with granulomas. Treatment with a high dose of steroids had an excellent clinical response. This case underscores the utility of PET CT in the assessment of this disease.
Subject(s)
Humans , Male , Aged , Aortitis/pathology , Aortitis/diagnostic imaging , Giant Cell Arteritis/pathology , Giant Cell Arteritis/diagnostic imaging , Aortitis/drug therapy , Temporal Arteries/pathology , Giant Cell Arteritis/drug therapy , Biopsy , Positron Emission Tomography Computed TomographyABSTRACT
Aneurismas da artéria temporal superficial são incomuns segundo a literatura. A grande maioria é secundária a traumatismos ou cirurgia na região temporal, sendo que 95% dos casos evoluem para pseudoaneurismas. Entretanto, os aneurismas verdadeiros ou espontâneos são extremamente raros e representam 8% dos casos de aneurismas da artéria temporal superficial, sendo estes, geralmente, de origem aterosclerótica. Aneurismas temporais espontâneos podem coexistir com outras lesões vasculares, incluindo aneurismas intracranianos. Nosso relato trata de um paciente com aneurisma de artéria temporal superficial esquerda, de origem aterosclerótica, no qual foi realizada a excisão cirúrgica, sob anestesia geral.
According to the literature, aneurysms of the superficial temporal artery are uncommon. The vast majority are secondary to trauma or surgery in the temporal region and 95% of cases progress to pseudoaneurysms. However, true or spontaneous aneurysms are extremely rare, accounting for 8% of cases of superficial temporal artery aneurysms, and are usually caused by atherosclerosis. Spontaneous temporal aneurysms can coexist with other vascular lesions, including intracranial aneurysms. Our report deals with a patient with an aneurysm of the left superficial temporal artery, of atherosclerotic origin, for whom surgical excision was performed under general anesthesia.
Subject(s)
Humans , Male , Aged , Aneurysm/diagnosis , Aneurysm/rehabilitation , Temporal Arteries/surgery , Temporal Arteries/pathology , Atherosclerosis/therapyABSTRACT
OBJECTIVE: To describe demographic features, disease manifestations and therapy in patients with giant cell arteritis from referral centers in Brazil. METHODS: A retrospective cohort study was performed on 45 giant cell arteritis patients from three university hospitals in Brazil. Diagnoses were based on the American College of Rheumatology classification criteria for giant cell arteritis or temporal artery biopsy findings. RESULTS: Most patients were Caucasian, and females were slightly more predominant. The frequencies of disease manifestations were as follows: temporal headache in 82.2%, neuro-ophthalmologic manifestations in 68.9%, jaw claudication in 48.9%, systemic symptoms in 44.4%, polymyalgia rheumatica in 35.6% and extra-cranial vessel involvement in 17.8% of cases. Aortic aneurysms were observed in 6.6% of patients. A comparison between patients with biopsy-proven giant cell arteritis and those without temporal artery biopsies did not yield significant differences in disease manifestations. All patients were treated with oral prednisone, and intravenous methylprednisolone was administered to nearly half of the patients. Methotrexate was the most commonly used immunosuppressive agent, and low-dose aspirin was prescribed to the majority of patients. Relapses occurred in 28.9% of patients, and aspirin had a protective effect against relapses. Females had higher prevalences of polymyalgia rheumatica, systemic manifestations and jaw claudication, while permanent visual loss was more prevalent in men. CONCLUSIONS: Most of the clinical features of Brazilian giant cell arteritis patients were similar to those found in other studies, except for the high prevalence of neuro-ophthalmic manifestations and permanent blindness in the Brazilian patients. Aspirin had a protective effect on relapses.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Giant Cell Arteritis/drug therapy , Giant Cell Arteritis/pathology , Temporal Arteries/pathology , Antirheumatic Agents/therapeutic use , Biopsy , Brazil , Methotrexate/therapeutic use , Methylprednisolone/therapeutic use , Prednisone/therapeutic use , Retrospective Studies , Risk Factors , Sex Factors , Statistics, NonparametricABSTRACT
Introducción: Los aneurismas de la arteria temporal superficial (AATS) constituyen una rara condición infrecuentemente reportada, ya que se han publicado sólo 14 casos de AATS ateroescleróticos en la literatura mundial. Este hecho contrasta con los aproximadamente 400 casos de pseudoaneurismas traumáticos de arteria temporal superficial reportados tanto en publicaciones nacionales, como internacionales. Reporte de Caso: Paciente femenino de 66 años de edad con antecedente de hipertensión arterial en tratamiento hace 17 años. El motivo de consulta fue la presencia de una masa pulsátil indolora en la región temporal derecha de 14 meses de evolución. Se estudió con ecografía Doppler vascular, la cual describe un aneurisma fusiforme de 2 cm de diámetro y 3 cm de longitud de la arteria temporal superficial. La cirugía consiste en la disección simple del aneurisma y la resección completa de la lesión con ligadura de los extremos proximales y distales de la arteria comprometida. El estudio histopatológico informa compromiso de las tres capas de la pared vascular en el área del aneurisma; también se observa la presencia de vasos adventiciales ateroescleróticos y engrasamiento ateroesclerótico de la íntima. La tinción de Van Gieson para fibras elásticas demuestra la integridad de la lámina elástica interna arterial. Conclusiones: Aún cuando los aneurismas verdaderos de la arteria temporal superficial son muy raros, su diagnóstico, estudio y tratamiento son relativamente simples y se encuentran actualmente bien establecidos.
Superficial temporal artery aneurysms (STAA) are an uncommon condition. Only 14 atherosclerotic STAA had been reported. This contrasts with almost 400 cases of superficial temporal artery traumatic pseudoaneurysms reported. We report a 66 years old female with hypertension treated for 17 years. She consulted for a painless pulsatile mass on the right temporal region lasting 14 months. A Doppler vascular ultrasound, described a superficial temporal artery fusiform aneurysm of 2 cm diameter and 3 cm length. The surgical exploration revealed the presence of the aneurysm compromising the superficial temporal artery. Simple dissection and resection of the lesion, ligating all the involved vascular branches was performed. The histopathological study reported involvement of all three layers of the vascular wall over the aneurysmatic area, also reported the presence of atherosclerotic adventitial vessels and atherosclerotic thickening of the intima. The Van Gieson stain for elastic fibers demonstrated integrity of the internal elastic layer.
Subject(s)
Humans , Female , Aged , Aneurysm/surgery , Aneurysm/diagnosis , Temporal Arteries/surgery , Atherosclerosis , Temporal Arteries/pathology , Ultrasonography, DopplerABSTRACT
Temporal or giant cell arteritis is the most common vasculitis affecting the temporal artery. We encountered an unusual case of involvement of the temporal artery, which showed marked proliferating capillaries admixed with a dense infiltrate of eosinophils affecting all layers of the vessel. It was concluded that these changes were those of an epithelioid hemangioma of the temporal artery.
Subject(s)
Angiolymphoid Hyperplasia with Eosinophilia/diagnosis , Epithelioid Cells/pathology , Giant Cell Arteritis/diagnosis , Hemangioma/diagnosis , Humans , Male , Middle Aged , Temporal Arteries/pathologyABSTRACT
La amiloidosis sistémica primaria y el mieloma múltiple con amiloidosis primaria se han presentado con características clínicas e histopatológicas que simulan una arteritis de células gigantes. Hasta el momento la asociación se basaba en el rol antigénico del depósito de amiloide sobre las arterias, desencadenando la respuesta inmune que finaliza con una arteritis. Presentamos el primer caso en la literatura de un paciente con mieloma múltiple y arteritis de células gigantes sin amiloidosis sistémica, sugiriendo una relación patogénica entre estas dos entidades. En el caso de nuestro paciente se descartó la presencia de amiloide en la pared arterial, por lo que proponemos que el estímulo para el desarrollo de la arteritis podría ser una excesiva producción de interleuquina 6 fabricada por las células mielomatosas
Primary systemic amyloidosis with clinical and histopathologic features of giant cell arteritis has already been described. The association of multiple myeloma (with primary amyloidosis) and giant cell arteritis is also known. We present the first case in the literature of a patient with multiple myeloma and giant cell arteritis without systemic amyloidosis, suggesting a pathogenic relationship between the two diseases
Subject(s)
Humans , Male , Aged , Amyloidosis/diagnosis , Multiple Myeloma/diagnosis , Temporal Arteries/pathology , Giant Cell Arteritis/diagnosis , Amyloidosis/etiology , Amyloidosis/pathology , Biopsy , Bone Marrow/pathology , Multiple Myeloma/complications , Multiple Myeloma/pathology , Giant Cell Arteritis/etiology , Giant Cell Arteritis/pathologyABSTRACT
El motivo de presentación de este cuadro clínico es la manifestación inicial atípica de una enfermedad arterial inflamatoria. Lo que generó la consulta de la paciente fue la sintomatología isquémica que padecía, con el desarrollo de claudicación de ambos miembros superiores, acompañado de un fenómeno de Raynaud y úlceras en la mano izquierda. Se describe la historia clínica de la paciente, cómo se llegó al diagnóstico de arteritis de la arteria temporal y los tratamientos realizados.
Subject(s)
Humans , Female , Giant Cell Arteritis/diagnosis , Aged, 80 and over , Anti-Inflammatory Agents/therapeutic use , Giant Cell Arteritis/drug therapy , Methylprednisolone/therapeutic use , Temporal Arteries/pathologyABSTRACT
Pseudoaneurysm arising from the superficial temporal artery (STA) is very rare and is most commonly caused by blunt trauma. Most pseudoaneurysms of the STA usually present as a painless pulsating mass, with concomitant symptoms according to location, and their size may rapidly increase. The treatment of choice is ligation and resection. We present a case of pseudoaneurysm arising from STA after a penetrating injury caused by broken glass. We describe the history, findings of physical examination, Doppler sonography, angiography, histopathology, and the outcome of treatment. We also include a brief review of this condition.
Subject(s)
Humans , Male , Aneurysm, False/surgery , Aneurysm, False/etiology , Aneurysm, False/diagnosis , Angiography, Digital Subtraction , Middle Aged , Temporal Arteries/surgery , Temporal Arteries/pathology , Temporal Arteries/injuries , Thrombosis/etiology , Ultrasonography, Doppler , Wounds, Penetrating/surgery , Wounds, Penetrating/complicationsABSTRACT
La arteritis de células gigantes (ACG), es una enfermedad vasculítica común en la población anciana. Muchas manifestaciones son frecuentemente desconocidas y su diagnóstico y apropiado tratamiento se postergan. En base a cinco observaciones personales, exponemos una revisión sobre etiopatogenia, clínica, paraclínica y tratamiento de diferentes formas de la enfermedad
Subject(s)
Humans , Male , Female , Middle Aged , Giant Cell Arteritis/diagnosis , Giant Cell Arteritis/drug therapy , Temporal Arteries/pathology , Biopsy , Prednisone/therapeutic useABSTRACT
La arteritis temporal o de células gigantes, en una vasculitis generalizada que afecta característicamente las arterias craneanas, de etiología desconocida, con cierta predilección racial y geográfica, cuya ocurrencia en nativos mexicanos no ha sido descrita. Informamos una paciente de 85 años, del centro del país y con ascendencia genética también local. Su historia de 3 meses de evolución con dolor, aumento de volumen y tortuosidad de arterias extracraneanas, manifestaciones de polimialgia reumática y amaurosis bilateral; cursó con eritrosedimentación elevada y en la biopsia de arteria temporal se evidenció el infiltrado inflamatorio y de células gigantes características. Con esteroides mejoró sólo parcialmente la agudeza visual. Destacamos la importancia de considerar esta patología, dado que el retraso en el diagnóstico y tratamiento puede resultar en secuelas permanentes
Subject(s)
Humans , Female , Aged , Giant Cell Arteritis/classification , Giant Cell Arteritis/diagnosis , Giant Cell Arteritis/physiopathology , Temporal Arteries/pathologySubject(s)
Humans , Female , Aged , Giant Cell Arteritis/pathology , Headache/pathology , Biopsy , Menopause/metabolism , Temporal Arteries/pathologyABSTRACT
An 80-year-old woman was admitted after a 4 months history of severe headache. Laboratory data revealed elevated ESR, mild anemia and alteration of liver function test. Temporal artery biopsy showed the classical picture of giant cell arteritis. The clinical symptoms and laboratory abnormalities reversed to normal after prednisolone therapy. Although the true prevalence of this disease is unknown in Thailand, previous studies in western countries have revealed that it is not a common disease. GCA may be missed or incorrectly diagnosed in elderly patients with headache and a high ESR. Such a diagnosis can subject the patient to complication of GCA, needless biopsy and serious side effects of therapy with large doses of prednisolone.
Subject(s)
Aged , Aged, 80 and over , Biopsy , Female , Giant Cell Arteritis/pathology , Giant Cells/pathology , Humans , Temporal Arteries/pathologyABSTRACT
We describe a series of 7 patients with temporal arteritis (TA), 5 of whom had undoubted TA and 2 almost certainly had TA. All presented with considerable morbidity but responded dramatically to treatment.
Subject(s)
Aged , Biopsy , Developing Countries , Female , Giant Cell Arteritis/diagnosis , Humans , Male , Middle Aged , Prednisolone/therapeutic use , Temporal Arteries/pathologyABSTRACT
We describe clinical, radiological and pathological findings in a case of herpes zoster ophthalmicus who developed contralateral hemiplegia. The CT scan showed discrete infarction of the right internal capsule and the right carotid angiogram showed concentric narrowing of the supraclinoid portion of right internal carotid artery. Superficial temporal artery biopsy showed infiltration by lymphocytes and plasma cells without any granuloma formation or giant cells. The importance of trigemino-vascular connections in the pathogenesis of this complication of herpes zoster ophthalmicus and the role of temporal artery biopsy in the diagnosis of arteritis following herpes zoster are discussed.
Subject(s)
Biopsy , Cerebral Infarction/pathology , Dominance, Cerebral/physiology , Giant Cell Arteritis/pathology , Hemiplegia/pathology , Herpes Zoster Ophthalmicus/pathology , Humans , Male , Middle Aged , Temporal Arteries/pathologyABSTRACT
Se presenta el caso clínico de un varón de 85 años, con odinogafia, los moniliasis bucal y deterioro del estado general, síntomas y signos que precederon la aparición de gangrena de lengua. Se postula como causa de la misma el compromiso de las arterias linguales por arteritis, lo cual fue confirmado por biopsia de la arteria temporal izquierda. El enfermo debió sufrir amputación de los tercios anteriores de la lengua, mejorando su cuadro general con la cirugía y la administración de corticosteroides