Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]
Overview
Vasculitis means inflammation of a blood vessel. Vasculitis is classified based on the size of vessels which are involved. Large sized-vessel vasculitis mostly happens in major vessels of the body, such as Takayasu’s Arteritis and temporal Arteritis. Medium sized-vessel vasculitis includes Kawasaki’s Disease and Polyarteritis Nodosa. Small sized-vessel vasculitis commonly manifests as skin lesions and includes Churg-Strauss Syndrome, leukocytoclastic vasculitis, Henoch-Schonlein Purpura, and Wegener’s Granulomatosis. Variable sized-vessel vasculitis are Sjogren syndrome and Cogan syndrome. Single organ vasculitis is basically primary central nervous system angiitis. As the affected vessels are vary in size, the affected organs could be different among patients which leads to different disease presentation and severities. This spectrum of diseases could be primary or secondary to another conditions like sepsis. A high degree of level of suspicious is necessary when encounter a patients with appropriate clinical manifestation to lead to final diagnosis. Diagnosis is based on a combination of clinical scenario, lab findings, and imaging findings. Although the definite diagnostic modality is tissue biopsy and microscopic findings. The diseases course could be acute although they usually presents with constitutional symptoms and chronic progression. Treatment of vasculitis depends on the disease severity consists of applying immunosuppressant agents to induce the remission and maintain the the disease course under control.
Classification
Large-sized vessel vasculitis
Medium-sized vessel vasculitis
Small-sized vessel vasculitis
Variable-sized vessel vasculitis
Single organ vasculitis
Causes in Alphabetical Order
Vasculitis could be a primary disorder or secondary to an underlying condition. Following is a list of common causes of underlying diseases or drugs that may lead to vasculitis syndrome:
Differentiating Vasculitis from Other Diseases
- As vasculitis manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype.
To review the differential diagnosis of large-sized vessel vasculitis, click here.
To review the differential diagnosis of large-sized vessel vasculitis with weight loss, click here.
To review the differential diagnosis of large-sized vessel vasculitis with arthralgia, click here.
To review the differential diagnosis of large-sized vessel vasculitis with claudication, click here.
To review the differential diagnosis of large-sized vessel vasculitis with hypertension, click here.
To review the differential diagnosis of medium-sized vessel vasculitis, click here.
To review the differential diagnosis of medium-sized vessel vasculitis with headache, click here.
To review the differential diagnosis of medium-sized vessel vasculitis with fever, click here.
To review the differential diagnosis of medium-sized vessel vasculitis with weight loss, click here.
To review the differential diagnosis of medium-sized vessel vasculitis with arthralgia, click here.
To review the differential diagnosis of medium-sized vessel vasculitis with claudication, click here.
To review the differential diagnosis of medium-sized vessel vasculitis with bruit, click here.
To review the differential diagnosis of medium-sized vessel vasculitis with hypertension, click here.
To review the differential diagnosis of medium-sized vessel vasculitis with focal neurological sign, click here.
To review the differential diagnosis of medium-sized vessel vasculitis with headache, fever, and focal neurological sign, click here.
To review the differential diagnosis of medium-sized vessel vasculitis with headache, fever, weight loss, and arthralgia, click here.
To review the differential diagnosis of medium-sized vessel vasculitis with headache, fever, weight loss, arthralgia, claudication, bruit, and hypertension, click here.
To review the differential diagnosis of small-sized vessel vasculitis, click here.
To review the differential diagnosis of small-sized vessel vasculitis with headache, click here.
To review the differential diagnosis of small-sized vessel vasculitis with fever, click here.
To review the differential diagnosis of small-sized vessel vasculitis with weight loss, click here.
To review the differential diagnosis of small-sized vessel vasculitis with arthralgia, click here.
To review the differential diagnosis of small-sized vessel vasculitis with claudication, click here.
To review the differential diagnosis of small-sized vessel vasculitis with hypertension, click here.
To review the differential diagnosis of small-sized vessel vasculitis with focal neurological sign, click here.
To review the differential diagnosis of small-sized vessel vasculitis with fever and headache, click here.
To review the differential diagnosis of small-sized vessel vasculitis with fever and weight loss, click here.
To review the differential diagnosis of small-sized vessel vasculitis with fever and arthralgia, click here.
To review the differential diagnosis of small-sized vessel vasculitis with fever and claudication, click here.
To review the differential diagnosis of small-sized vessel vasculitis with fever and focal neurological sign, click here.
To review the differential diagnosis of small-sized vessel vasculitis with fever, weight loss, and arthralgia, click here.
To review the differential diagnosis of small-sized vessel vasculitis with fever, weight loss, and focal neurological sign, click here.
To review the differential diagnosis of small-sized vessel vasculitis with fever, headache, weight loss, arthralgia, and claudication, click here.
To review the differential diagnosis of small-sized vessel vasculitis with fever, headache,weight loss, arthralgia, claudication, hypertension, and focal neurological sign, click here.
To review the differential diagnosis of variable-sized vessel vasculitis, click here.
To review the differential diagnosis of single organ vasculitis, click here.
Abbreviations:
ABG= Arterial blood gas, ANA= Antinuclear antibody, ANP= Atrial natriuretic peptide, ASO= Antistreptolysin O antibody, BNP= Brain natriuretic peptide, CBC= Complete blood count, COPD= Chronic obstructive pulmonary disease, CRP= C-reactive protein, CT= Computed tomography, CXR= Chest X-ray, DVT= Deep vein thrombosis, ESR= Erythrocyte sedimentation rate, HRCT= High Resolution CT, IgE= Immunoglobulin E, LDH= Lactate dehydrogenase, PCWP= Pulmonary capillary wedge pressure, PCR= Polymerase chain reaction, PFT= Pulmonary function test.
| Diseases
|
Clinical manifestations
|
Para-clinical findings
|
Gold standard
|
Additional findings
|
| Symptoms
|
Physical examination
|
| Lab Findings
|
Imaging
|
Histopathology
|
| Headache
|
Fever
|
Weight loss
|
Arthralgia
|
Claudication
|
Bruit
|
HTN
|
Focal neurological disorder
|
Biomarker
|
CBC
|
ESR
|
Other
|
CT scan
|
Angiography
|
Ultrasound/ Echocardiography
|
Other
|
| Large-Vessel Vasculitis
|
Takayasu arteritis[1]
|
+
|
+/-
|
+
|
–
|
+
|
+
|
+/-
|
+/-
|
MMP-3 and MMP-9
|
Leukocytosis, Anemia
|
↑
|
↑CRP
|
Aneurysmal dilatation of the aorta
|
Blood vessel stenosis
|
Circumferential thickening of the arterial wall (Macaroni sign)
|
PET-scan, Cardiac CT
|
Granulomatous inflammation of arteries
|
Arteriography
|
Coronary aneurysm
|
| Giant cell arteritis[2]
|
+
|
–
|
+
|
+/-
|
–
|
–
|
–
|
+/-
|
Pentraxin 3 (PTX3)
|
Normal
|
↑
|
↑CRP
|
Stenosis, Occlusion, Dilatation
|
Aneurysm
|
–
|
Mural inflammation in MRA
|
Granulomatous inflammation of arteries
|
Biopsy
|
Jaw pain and claudication
|
| Neurological disease
|
Cerebral aneurysm[3]
|
+
|
–
|
–
|
–
|
–
|
–
|
+/-
|
+
|
–
|
Normal
|
Normal
|
–
|
Well-defined round, slightly hyperattenuating lesion
|
Bulging out of the main lumen
|
–
|
Heterogeneous signal intensity in MRA
|
Layers of smooth muscle cells, Intact endothelium
|
Digital subtraction angiography (DSA)
|
Nausea, Vomiting
|
| Neurofibromatosis type 1[4]
|
+/-
|
–
|
+/-
|
–
|
–
|
–
|
+
|
+
|
NF1 mutated gene
|
Normal
|
Normal
|
Neurofibromin gene
|
Bone abnormalities
|
Optical coherence tomography angiography (OCTA)
|
–
|
Optic nerve gliomas in MRI
|
Elongated spindle-shaped cells in neurofibromas
|
NIH diagnostic criteria
|
Cafe au Lait spot
|
| Neurofibromatosis type 2[5]
|
+/-
|
–
|
+/-
|
–
|
+/-
|
–
|
–
|
+
|
NF2 mutated gene
|
Normal
|
Normal
|
Schwannomin
|
Meningioma, Schwannoma, Ependymoma
|
Fluorescein angiography showed retinal hamartoma
|
Localized schwannomas in nerve ultrasound
|
Schwannoma in MRI
|
Encapsulated biphasic nerve sheath tumor
|
NIH diagnostic criteria
|
Hearing loss, Vision loss
|
| Systemic disease
|
Fibromuscular dysplasia[6]
|
+
|
–
|
+/-
|
+
|
+
|
+
|
+
|
+/-
|
Transforming growth factor β (TGF-β)
|
Normal
|
↑
|
↑ Cr or BUN
|
Alternating stenosis and dilatations in CT angiography
|
Stenosis in the renal arteries
|
Luminal narrowing alternating with dilatation (Beads sign)
|
Focal concentric, long-segment tubular stenosis or outpouching in MRA
|
Fibrodysplastic changes, Collagen deposition
|
Digital subtraction angiography (DSA)
|
Spontaneous coronary artery dissection (SCAD)
|
| Ehlers-Danlos syndrome[7]
|
–
|
–
|
–
|
+
|
+/-
|
+/-
|
–
|
+/-
|
TGF-β
|
Normal
|
Normal
|
Cultured skin fibroblasts
|
Multiple vascular segments with aneurysms and dissections
|
Dissection of the posterolateral branch of the left circumflex coronary artery (LCx)
|
Visceral arteries abnormality
|
Vascular abnormalities in MRA
|
Thin and rare collagen bundles in the dermis
|
History and physical examination
|
Bleeding, Bruisability, Heart murmur
|
| Polymyalgia rheumatica (PMR)[8]
|
+
|
–
|
+/-
|
+
|
–
|
–
|
–
|
–
|
Plasma fibrinogen
|
Normocytic, normochromic anemia
|
↑
|
CRP
|
Periodontoid localization of calcification
|
Vessel wall thickening, Increased mural contrast enhancement
|
Subacromial or subdeltoid bursitis
|
High F-FDG accumulation around the joints in FDG PET-CT
|
Small angular fibers, Pyknotic nuclear clumps, or target-targetoid fibers
|
–
|
Joint stiffness, Fatigue
|
| Amyloidosis[9]
|
+/-
|
–
|
–
|
+/-
|
+/-
|
–
|
+
|
+
|
Immunoglobulin light chain(Amyloid)
|
Anemia
|
Normal
|
↑ Cr or BUN,
↑ ALT or AST
|
Diffusely hypoattenuating and enlarged liver
|
Amyloid deposition in the media and adventitia of small arteries
|
Solid organs increased echogenicity
|
Tc-DPD for cardiac amyloid deposits
|
Extracellular deposition of fibrillar proteins
|
Biopsy
|
Cardiomegaly, Dyspnea
|
| Diseases
|
Headache
|
Fever
|
Weight loss
|
Arthralgia
|
Claudication
|
Bruit
|
HTN
|
Focal neurological disorder
|
Biomarker
|
CBC
|
ESR
|
Other
|
CT scan
|
Angiography
|
Ultrasound/ Echocardiography
|
Other
|
Histopathology
|
Gold standard
|
Additional findings
|
| Medium-Vessel Vasculitis
|
Polyarteritis nodosa[10]
|
+
|
+
|
+
|
+
|
+
|
+
|
+/-
|
+/-
|
LAMP-2 protein autoantibodies
|
Leukocytosis, Normochromic anemia, Thrombocytosis
|
↑
|
↑ Cr or BUN,
↑ ALT or AST, Proteinuria
|
Focal regions of infarction or hemorrhage
|
Multiple microaneurysms, Hemorrhage due to focal rupture, Occlusion
|
Aneurysms and renal arteriovenous fistula in color Doppler sonography
|
–
|
Necrotizing inflammatory lesions
|
Angiography
|
Sudden weight loss, Abdominal pain
|
| Hepatitis B virus-associated polyarteritis nodosa[11]
|
+/-
|
+/-
|
+
|
+
|
+/-
|
+/-
|
+
|
–
|
HBsAg
|
Leukocytosis, Normochromic anemia, Thrombocytosis
|
↑
|
↑ ALT or AST
|
Focal regions of infarction or hemorrhage
|
Microaneurysms in mesenteric artery
|
Aneurysms and renal arteriovenous fistula in color Doppler sonography
|
–
|
Necrotizing inflammatory lesions
|
Angiography
|
Peripheral neuropathy, Livedo reticularis
|
| Kawasaki disease[12]
|
–
|
+
|
+/-
|
+
|
+
|
–
|
+/-
|
–
|
NT-proBNP, Meprin A, Filamin C
|
Normochromic anemia, ↑WBC with a left shift, Thrombocytosis
|
↑
|
Acute-phase reactants, ↓Cholesterol, ↓HDL, ↓ApolipoA
|
Coronary artery calcifications
|
Coronary artery aneurysms, stenosis or occlusion
|
Coronary artery anomaly in echocardiography
|
Electron beam CT (EBCT)
|
Acute destruction of the media by neutrophils, with loss of elastic fibers
|
History and physical examination
|
Diarrhea, Vomiting
|
| Infectious disease
|
Parvovirus B19 infection[13]
|
+
|
+
|
+
|
+
|
–
|
–
|
–
|
+/-
|
B19 DNA, ↓Reticulocyte count
|
Anemia
|
↑
|
anti–parvovirus B19 IgM
|
–
|
–
|
Hydrops in fetal ultrasonography
|
–
|
–
|
B19 DNA
|
Purpuric rash, Erythema multiforme
|
| Scarlet fever[14]
|
+
|
+
|
+/-
|
+
|
–
|
–
|
–
|
–
|
Antistreptolysin-O (ASO) titers
|
Leukocytosis
|
↑
|
↑CRP
|
Thickened pulmonary markings if pneumonia
|
–
|
–
|
–
|
Sparse neutrophilic perivascular infiltrate
|
History and physical examination
|
Sand-paper rashes, Sore throat
|
| Toxic shock syndrome[15]
|
+
|
+
|
+
|
+
|
–
|
–
|
–
|
+/-
|
Procalcitonin
|
Leukocytosis with left shift
|
↑
|
Myoglobinuria, Sterile pyuria
|
Acute respiratory distress syndrome
|
–
|
–
|
–
|
Necrolysis of keratinocytes in epidermis, Perivascular lymphocytic infiltrate
|
Clinical criteria
|
Peeling or rashes, Organ dysfunction
|
| Mononucleosis[16]
|
+
|
+
|
+
|
+
|
–
|
–
|
–
|
–
|
EBV DNA
|
Atypical lymphocyte
|
↑
|
Heterophile antibodies
|
CNS involvement
|
–
|
Splenomegaly
|
Encephalitis in MRI
|
Lymphoproliferative response in oropharynx, Lymphocytic infiltration in spleen
|
Heterophile antibody test
|
Splenomegaly, Palatal petechiae
|
| Leptospirosis[17]
|
+
|
+
|
+
|
+
|
+/-
|
–
|
–
|
–
|
IL-6, IL-8 and IL-10
|
Anemia
|
–
|
↑Cr or BUN,
↑ALT or AST, Proteinuria
|
Diffuse alveolar hemorrhage
|
–
|
–
|
–
|
Toxin-mediated break down of endothelial cell membranes of capillaries
|
Culture and the microscopic agglutination test
|
Red eyes, Skin rash
|
| Lyme Disease[18]
|
+/-
|
+
|
+/-
|
+
|
+/-
|
–
|
–
|
–
|
CXCL9 (MIG), CXCL10 (IP-10) and CCL19 (MIP3B)
|
Leukopenia, Thrombocytopenia
|
–
|
Microscopic hematuria, Proteinuria, ↑ALT or AST
|
Punctate lesions in periventricular white matter in brain SPECT
|
–
|
–
|
–
|
Acrodermatitis chronica atrophicans
|
Serologic tests
|
Erythema migrans
|
| Measles[19]
|
+/-
|
+
|
+/-
|
+
|
–
|
–
|
–
|
–
|
Measles IgM
|
Leukopenia, Lymphocytosis, Thrombocytopenia
|
–
|
↑ALT or AST
|
Pneumonia
|
–
|
–
|
CXR
|
Spongiosis and vesiculation in the epidermis with scattered dyskeratotic keratinocytes
|
PCR
|
Generalized rash, Cough, Coryza, or Conjunctivitis
|
| Rocky Mountain Spotted Fever[20]
|
+
|
+
|
+
|
+
|
–
|
–
|
–
|
–
|
R rickettsii serology
|
Thrombocytopenia, Anemia
|
–
|
↑ALT or AST, Hyponatremia
|
Infarction, edema, and meningeal enhancement
|
–
|
Myocardial or conduction abnormalities in echocardiography
|
–
|
Immunofluorescent or immunoperoxidase staining of R rickettsii
|
Clinical criteria and tick exposure
|
Rash on the palms and soles
|
| Staphylococcal Scalded Skin Syndrome[21]
|
+
|
+
|
+
|
+
|
–
|
–
|
+/-
|
+/-
|
Anti exfoliatin and anti alpha-toxin antibodies
|
Leukocytosis with left shift
|
↑
|
Blood culture
|
Pneumonia
|
–
|
–
|
–
|
Intraepidermal blister, dense superficial perivascular lymphohistiocytic infiltrate
|
Blood culture and clinical findings
|
Widespread skin erythema, fluid-filled blisters
|
| Toxic Epidermal Necrolysis[22]
|
–
|
+
|
+
|
–
|
–
|
–
|
–
|
+/-
|
MicroRNA-124
|
Normochromic normocytic anemia, Eosinophilia
|
↑
|
Fluid loss and electrolyte abnormalities
|
Tracheobronchial inflammation
|
–
|
–
|
–
|
Necrotic keratinocytes with full-thickness epithelial necrosis
|
Histopathology and clinical findings
|
Erythematous macular rash with purpuric centers
|
| Cardiovascular disease
|
Atrial Myxoma[23]
|
–
|
–
|
+/-
|
–
|
–
|
–
|
–
|
+/-
|
Calretinin
|
Mild anemia, Leukocytosis
|
↑
|
↑IL-6
|
Atrial filling defect larger than a thrombus
|
–
|
Tumor location, size, attachment, and mobility in echocardiography
|
Size, shape, and surface characteristics in MRI
|
Lipidic cells embedded in a vascular myxoid stroma
|
Echocardiography
|
Dyspnea on exertion, Syncope
|
| Cholesterol Embolism[24]
|
+/-
|
+/-
|
–
|
–
|
+
|
–
|
–
|
+
|
IL-5
|
Eosinophilia, Leukocytosis
|
↑
|
Eosinophiluria
|
Thoracic and abdominal aortic sources of embolism
|
Atheroembolism in abdominal aorta and the lower extremity arteries
|
Excluding an intracardiac source of embolism with echocardiography
|
–
|
Birefringent crystals or biconvex needle-shaped ghostly clefts within the arterial lumen
|
Angiography
|
Livedo reticularis,
Ischemic patches
|
| Segmental arterial mediolysis[25]
|
+
|
–
|
–
|
–
|
+
|
+
|
+
|
+/-
|
–
|
Leukocytosis
|
–
|
–
|
Visceral artery aneurysm in CT angiography
|
Alternating aneurysms and stenoses (beading)
|
Retroperitoneal hematoma
|
–
|
Disruption of the smooth muscle in the media
|
Angiography
|
Hematuria, Ischemic colitis
|
| Systemic disease
|
Antiphospholipid Syndrome[26]
|
+
|
+
|
–
|
–
|
–
|
–
|
–
|
+/-
|
Antiphospholipid antibodies
|
Thrombocytopenia, Hemolytic anemia
|
–
|
Lupus anticoagulant (LA)
|
Stroke,
Pulmonary embolism, Budd-Chiari syndrome
|
Thrombus in major vessels
|
Valve thickening, vegetations, or insufficiency in echocardiography
|
–
|
Noninflammatory bland thrombosis without perivascular inflammation
|
Hx of thrombosis and antiphospholipid antibodies
|
Miscarriage, Pulmonary hypertension
|
| Juvenile Idiopathic Arthritis[27]
|
–
|
–
|
–
|
+
|
+/-
|
–
|
–
|
–
|
Rheumatoid factor (RF), S100A12
|
Lymphocytosis, Thrombocytopenia
|
↑
|
Myeloid-related proteins 8/14 (MRP8/14)
|
Synovial hypertrophy, Joint effusions
|
Cerebral vasculitis
|
Inflamed synovium
|
Bone scanning
|
Vascular congestion, RBC extravasation, Venular lumen occlusion
|
Conventional radiography
|
Evanescent rash, Dactylitis
|
| Diseases
|
Headache
|
Fever
|
Weight loss
|
Arthralgia
|
Claudication
|
Bruit
|
HTN
|
Focal neurological disorder
|
Biomarker
|
CBC
|
ESR
|
Other
|
CT scan
|
Angiography
|
Ultrasound/ Echocardiography
|
Other
|
Histopathology
|
Gold standard
|
Additional findings
|
| Small-Vessel Vasculitis
|
ANCA-associated vasculitis
|
Microscopic polyangiitis[28]
|
+
|
–
|
–
|
+/-
|
–
|
–
|
–
|
+
|
Anti-PR3 antibody (C-ANCA) (40%), Anti-MPO antibody (P-ANCA) (60%)
|
Leukocytosis, Normocytic anemia
|
↑
|
Proteinuria, Erythrocyte casts
|
Suspected pancreatitis
|
Mesenteric angiography for differentiating from polyarteritis nodosa
|
–
|
Bilateral nodular, and patchy opacities in CXR
|
Glomerulonephritis with focal necrosis, crescent formation, and lack or paucity of immunoglobulin deposits
|
Histological confirmation
|
Rash, Hemoptysis
|
| Granulomatosis with polyangiitis (Wegener’s)[29]
|
+
|
+/-
|
+/-
|
–
|
–
|
–
|
–
|
+
|
Anti-PR3 antibody (C-ANCA) (90%), Anti-MPO antibody (P-ANCA) (10%)
|
Leukocytosis, Normochromic normocytic anemia
|
↑
|
↑Cr or BUN, Hypoalbuminemia
|
Consolidation, Patchy or diffuse ground-glass opacities
|
Occlusion or stenosis of LAD and RCA in coronary angiography
|
–
|
Single or multiple nodules and masses with cavitation in CXR
|
Parenchymal necrosis, Granulomatous inflammation
|
Histological confirmation
|
Conjunctivitis,
Episcleritis,
Uveitis,
Optic nerve vasculitis
|
| Eosinophilic granulomatosis with polyangiitis
(Churg-Strauss)[30]
|
+/-
|
–
|
–
|
+
|
–
|
–
|
–
|
+
|
Anti-MPO antibody (P-ANCA) (40%), Eotaxin-3
|
Eosinophilia, Anemia
|
↑
|
↑Cr or BUN, Proteinuria, Erythrocyte casts, ↑IgE levels
|
Significant enlargement of peripheral pulmonary arteries
|
Myocardial ischemia and infarction in coronary angiography
|
Congestive heart failure (CHF) in echocardiography
|
Extensive air-space opacities in CXR
|
Small necrotizing granulomas with eosinophilic core surrounded by macrophages and epithelioid giant cells
|
Histological confirmation
|
Allergic rhinitis, Asthma, Urticarial rash
|
| Hydralazine-associated ANCA-associated vasculitis[31]
|
–
|
–
|
–
|
+
|
–
|
–
|
–
|
+/-
|
Anti-MPO antibody (P-ANCA), Anti-histone antibodies
|
Anemia
|
–
|
↑Cr or BUN, Hypoalbuminemia
|
Bilateral pulmonary infiltrates
|
Aneurysms or occlusions of the visceral arteries
|
–
|
–
|
Pauci-immune necrotizing and crescentic glomerulonephritis
|
Histological confirmation
|
Sinusitis, Hemoptysis
|
| Immune complex small-vessel vasculitis
|
Anti-glomerular basement membrane disease[32]
|
+
|
+/-
|
–
|
–
|
–
|
–
|
+
|
–
|
Anti-GBM antibodies
|
Hypochromic microcytic anemia, Thrombocytopenia
|
–
|
↓C3 level
|
Pulmonary hemorrhage
|
–
|
Normal kidneys
|
Alveolar infiltrates spreading from the hilum in CXR
|
Cellular crescents in the glomeruli, Intra-alveolar hemorrhages
|
Anti-GBM antibodies
|
Hemoptysis, Hematuria
|
| Cryoglobulinemic vasculitis[33]
|
+/-
|
+/-
|
–
|
+
|
+/-
|
–
|
–
|
–
|
C4 component
|
Leukocytosis, Anemia
|
↑
|
ANA, hypocomplementemia
|
R/O underlying malignancy
|
Stenosis or occlusions of the visceral arteries
|
Bacterial endocarditis in echocardiography
|
Interstitial involvement or pleural effusions in CXR
|
HCV-associated proteins in vasculitic skin, Intraluminal cryoglobulin deposits
|
Histological confirmation
|
Acrocyanosis, Retinal hemorrhage, Purpura
|
| Hepatitis C virus-associated cryoglobulinemic vasculitis[34]
|
+/-
|
+/-
|
+
|
+
|
–
|
–
|
+
|
+/-
|
HCV RNA, Cryoglobulins
|
Leukocytosis, Anemia
|
↑
|
↓Serum C4, Positive RF
|
Increased hepatic echogenicity
|
–
|
Hepatomegaly, Splenomegaly
|
Increased hepatic echogenicity in MRI
|
Vasculitic skin, Antigen infilteration in lesions
|
HCV RNA, Histological confirmation
|
Palpable purpura, Microscopic hematuria
|
| IgA vasculitis (Henoch-Schönlein purpura)[35]
|
–
|
–
|
+
|
+
|
–
|
–
|
–
|
–
|
IgA
|
Normochromic anemia, Leukocytosis
|
↑
|
Stool OB, ↓C3, ↓C4
|
–
|
–
|
Increased bowel wall thickness, hematomas, peritoneal fluid, and intussusception
|
Dilated loops of bowel consistent in abdominal X-ray
|
Leukocytoclastic vasculitis in postcapillary venules with IgA deposition
|
History and physical examination
|
Hematuria, Palpable purpura
|
| Hypocomplementemic urticarial vasculitis (anti-C1q vasculitis)[36]
|
–
|
–
|
+/-
|
+
|
–
|
–
|
–
|
–
|
C1q
|
Mild anemia
|
↑
|
ANA, ↓C1q, ↓C3, ↓C4
|
–
|
–
|
Hepatomegaly, Splenomegaly
|
–
|
Deposits of immunoglobulins, complement, or fibrin around blood vessels
|
Urticaria,
Histological confirmation
|
Urticaria, Hematuria
|
| Gastrointestinal disease
|
Acute mesenteric ischemia[37]
|
–
|
+/-
|
–
|
–
|
–
|
–
|
–
|
–
|
I-FABP, Alpha-GST, Ischemia-modified albumin (IMA)
|
Leukocytosis, ↑HCT
|
–
|
↑Amylase
|
Bowel wall thickening, Intestinal pneumatosis, Portomesenteric thrombosis
|
Mesenteric venous thrombosis
|
Arterial stenosis or occlusion of the celiac or superior mesenteric arteries in duplex ultrasound
|
Ileus with distended loops of bowel, Bowel wall thickening in abdominal X-ray
|
Superficial mucosal hemorrhage, edema and necrosis
|
History and physical examination
|
Abdominal pain, Distension, Absent bowel sounds
|
| Cardiovascular disease
|
Infective Endocarditis[38]
|
+
|
+
|
+
|
–
|
–
|
–
|
–
|
+
|
NT-proBNP
|
Normochromic-normocytic anemia
|
↑
|
Hyperglobulinemia, Cryoglobulinemia
|
Metastatic infections, such as splenic infarct, renal infarcts, or psoas abscess
|
–
|
Vegetation, abscess, or new dehiscence of a prosthetic valvein echocardiography
|
Vertebral osteomyelitis in MRI
|
Vegetation or intracardiac abscess demonstrating active endocarditis
|
Echocardiography (TTE)
|
Janeway lesions, Osler nodes, Roth spots, Vertebral osteomyelitis
|
| Leukocytoclastic Vasculitis[39]
|
+
|
–
|
–
|
+
|
–
|
–
|
–
|
+
|
IgM, IgA, IgG
|
Leukocytosis, Anemia
|
↑
|
Hypocomplementemia
|
–
|
Vascular stenosis and obstruction in visceral angiography
|
–
|
–
|
Perivascular inflammatory infiltrate of neutrophils with leukocytoclasia (releasing nuclear debris)
|
Histological confirmation
|
Palpable purpura, Petechiae
|
| Pulmonary disease
|
Langerhans Cell Histiocytosis[40]
|
+/-
|
–
|
–
|
+
|
–
|
–
|
–
|
–
|
CD1a, CD207,BRAF-V600E
|
Anemia
|
↑
|
Hypercalcemia
|
Pulmonary cysts and nodules, Bone lytic lesions
|
–
|
Hepatomegaly, Splenomegaly
|
Cerebellum and pons hyperintensity in MRI
|
Birbeck granules by electron microscopy
|
Histological confirmation
|
Brown to purplish papules, Eczematous rash
|
| Non-Small Cell Lung Cancer[41]
|
–
|
+/-
|
+
|
–
|
–
|
–
|
–
|
+/-
|
EGFR, ROS1, EML4-ALK, PD-L1
|
Leukocytosis, Anemia
|
↑
|
Hypercalcemia, Hyponatremia
|
Pulmonary lesion or mass
|
–
|
Pulmonary marginal lesions
|
Staging and response to treatment in PET-CT
|
Adenocarcinoma, Squamous cell carcinoma
|
High resolution CT-scan
|
Cough, Hemoptysis
|
| Small Cell Lung Cancer[42]
|
–
|
+/-
|
+
|
–
|
–
|
–
|
–
|
+/-
|
p53, Thyroid transcription factor-1 (TTF1)
|
Anemia
|
↑
|
Hyponatremia
|
Large hilar mass with bulky mediastinal adenopathy
|
–
|
Endobronchial ultrasound (EBUS)
|
Standard staging
|
Spindled cells with dark nuclei, scant cytoplasm, and fine, granular nuclear chromatin
|
High resolution CT-scan
|
Cough, Hemoptysis
|
| Pulmonary Infarction[43]
|
+/-
|
–
|
–
|
–
|
–
|
–
|
+
|
–
|
D-dimer
|
Mild leukocytosis, Mild anemia
|
–
|
Hypoxemia, Hypocarbia or Hypercarbia, Respiratory alkalosis
|
Pulmonary embolism
|
Low-density filling defect within the pulmonary artery
|
Pericardial effusion in echocardiography
|
Pulmonary infiltrates, atelectasis, and pleural effusions in CXR
|
Infarct induced apoptosis
|
Pulmonary artery angiography
|
Cough, Hemoptysis
|
| Renal disease
|
Acute Poststreptococcal Glomerulonephritis[44]
|
–
|
–
|
–
|
+
|
–
|
–
|
+
|
+/-
|
Antistreptolysin-O (ASO) titers
|
Leukocytosis
|
↑
|
Hypocomplementemia
|
–
|
–
|
Normal to slightly enlarged kidneys
|
Central venous congestion in a hilar pattern in CXR
|
Hypercellularity of endothelial and mesangial cells, Infiltration of the glomerular tuft with polymorphonuclear cells
|
Histological confirmation
|
Hematuria
|
| Hematologic disease
|
Hemolytic-Uremic Syndrome[45]
|
+
|
+
|
–
|
+
|
–
|
–
|
+
|
+
|
C5b-9, ADAMTS13
|
Anemia, Thrombocytopenia, Reticulocytosis
|
↑
|
↑Lactate dehydrogenase (LDH), Hypercalcemia
|
Thalami, brainstem, or cerebellum abnormality
|
Cerebral microangiopathy or hypertension
|
Hypoechoic kidney
|
Abnormal hyperintensity in the brain cisterns in MRI
|
Microthromboses include fibrin thrombi that may occlude the glomerular tuft
|
Clinical findings coupled with laboratory abnormalities
|
Hematuria, Proteinuria
|
| Chronic Lymphocytic Leukemia (CLL)[46]
|
+
|
+
|
+
|
+
|
+/-
|
–
|
–
|
+/-
|
CD5, CD19, CD20, IgVH
|
Absolute lymphocytosis, Smudge cells
|
↑
|
Flow cytometry
|
Staging
|
–
|
–
|
–
|
Large atypical cells, cleaved cells, and prolymphocytes
|
Chromosomal and genetic testing
|
Easy bruising
|
| Multiple Myeloma[47]
|
+
|
–
|
+
|
+
|
+
|
+
|
+/-
|
+/-
|
Ig light chain
|
Anemia, Thrombocytopenia, Leukopenia
|
↑
|
Bone marrow aspiration and biopsy, ↑Cr
|
Osseous involvement and lytic lesions
|
Peripheral zone of increased vascularity in lesions
|
–
|
Punched-out lesion in skull X-ray
|
Clonal proliferation of plasma cells
|
Protein electrophoresis plus conventional X-rays
|
Constipation
|
| Hypereosinophilic Syndrome[48]
|
+/-
|
+/-
|
–
|
–
|
–
|
–
|
–
|
–
|
IgE, CD117 with CD2
|
Eosinophilia
|
–
|
↑Serum tryptase
|
Lymphadenopathy and splenomegaly
|
–
|
Intracardiac thrombi in echocardiography
|
–
|
Reticulin stain for myelofibrosis and tryptase staining for mast cells
|
Clinical findings coupled with laboratory abnormalities
|
Splinter hemorrhages, Raynaud phenomenon
|
| Non-Hodgkin Lymphoma[49]
|
+
|
+
|
+
|
+
|
+/-
|
+/-
|
+/-
|
+/-
|
MYC, BCL2, BCL6, and TP53
|
Lymphocytosis, Anemia, Thrombocytopenia
|
↑
|
↑Lactate dehydrogenase (LDH), Hypercalcemia
|
Enlarged lymph nodes, Hepatosplenomegaly, Filling defects in the liver and spleen
|
–
|
Hepatosplenomegaly
|
Mediastinal lymphadenopathy
|
Small cleaved or noncleaved, intermediate, or large cell with a follicular or diffuse pattern
|
Surgically excised tissue biopsy
|
Easy bruising, Testicular mass, Skin lesion
|
| Serum Sickness[50]
|
+
|
+
|
–
|
+/-
|
+/-
|
–
|
–
|
+/-
|
IL-1, IL-6, TNF
|
Leukopenia
|
↑
|
Polyclonal gammopathy, ↑Cr, Cryoglobulinemia
|
–
|
–
|
–
|
–
|
Arteritic lesions are focal, necrotizing, and inflammatory involving all layers of the artery
|
Clinical findings coupled with laboratory abnormalities
|
Hematuria, Skin rash
|
| Disseminated Intravascular Coagulation[51]
|
+/-
|
+
|
–
|
+/-
|
–
|
–
|
+
|
+
|
Fibrin degradation product (FDP)
|
Thrombocytopenia, Schistocytes
|
↑
|
↑D-dimer, aPTT and PT
|
Intracranial hemorrhage
|
–
|
–
|
–
|
Ischemia and necrosis due to fibrin deposition in small and medium-sized vessels
|
Clinical findings coupled with laboratory abnormalities
|
Acral cyanosis, Hemorrhagic skin infarctions
|
| Idiopathic Thrombocytopenic Purpura[52]
|
+
|
+/-
|
–
|
+
|
–
|
–
|
–
|
+
|
FC gamma receptors (FCGR) IIb
|
Anemia, Thrombocytopenia
|
–
|
HIV, ANA
|
R/O other causes
|
–
|
R/O splenomegaly
|
–
|
Increased number of normal morphologic megakaryocytes
|
Clinical findings coupled with thrombocytopenia
|
Easy bruising, Purpura
|
| Systemic disease
|
Sarcoidosis[53]
|
+
|
+
|
+
|
+
|
–
|
–
|
–
|
+/-
|
IL-2 and IFN-γ
|
Mild anemia
|
↑
|
↑ACE, ↑1, 25-dihydroxyvitamin D
|
Active alveolitis or fibrosis
|
–
|
Hepatosplenomegaly
|
Bilateral hilar adenopathy
|
Noncaseating granulomas (NCGs)
|
Histological confirmation
|
Heart block, Ocular lesion
|
| Legionella Infection[54]
|
+
|
+
|
+
|
+
|
–
|
–
|
–
|
+/-
|
Inflammatory cytokines
|
Leukocytosis with left shift, Thrombocytosis
|
↑
|
↑D-dimer, FDP, Hyponatremia
|
Pleural effusion
|
–
|
–
|
Nonspecific and indistinguishable CXR
|
Intra-alveolar inflammation, Microabscesses in the parenchyma
|
Sputum culture
|
Cough, Diarrhea
|
| Systemic lupus erythematosus[55]
|
+
|
+
|
+
|
+
|
–
|
–
|
+
|
+
|
Anti dsDNA, ANA
|
Leukopenia, Lymphopenia, Anemia, Thrombocytopenia
|
↑
|
↑Cr or BUN,
↑ALT or AST, Proteinuria
|
Interstitial lung disease, Pneumonitis, Pulmonary emboli, Alveolar hemorrhage
|
Aneurysms
|
Pericardial effusion, pulmonary hypertension, or verrucous Libman-Sacks endocarditis in echocardiography
|
Central nervous system (CNS) lupus white-matter changes in MRI
|
Staging lupus nephritis
|
Anti-dsDNA antibody test
|
Skin rashes or photosensitivity
|
| Rheumatoid arthritis[56]
|
–
|
–
|
+
|
+
|
+
|
+
|
–
|
–
|
RF, Anti-CCP antibody
|
Anemia
|
↑
|
↑Cr or BUN,
↑ALT or AST, ANA
|
Microfractures
|
Aneurysms
|
Effusions in joints
|
Basilar invagination with cranial migration of an eroded odontoid peg in MRI
|
Influx of inflammatory cells into the synovial membrane, with angiogenesis, proliferation of chronic inflammatory cells
|
Clinical findings coupled anti-CCP antibody
|
Rheumatoid nodules
|
| Relapsing polychondritis[57]
|
–
|
+/-
|
+/-
|
+
|
+
|
–
|
–
|
–
|
–
|
Leukocytosis, Anemia
|
–
|
Cryoglobulins, ANA, C-ANCA
|
Calcification of cartilaginous structures
|
Aortic root dilatation
|
Aortic root dilatation and degree of aortic regurgitation in echocardiography
|
Tracheal stenosis in CXR
|
Chondrolysis, Chondritis, Perichondritis
|
Clinical findings coupled with imaging
|
Ear pain and redness, Polyarthritis
|
| Diseases
|
Headache
|
Fever
|
Weight loss
|
Arthralgia
|
Claudication
|
Bruit
|
HTN
|
Focal neurological disorder
|
Biomarker
|
CBC
|
ESR
|
Other
|
CT scan
|
Angiography
|
Ultrasound/ Echocardiography
|
Other
|
Histopathology
|
Gold standard
|
Additional findings
|
| Variable-vessel vasculitis
|
Behçet’s syndrome[58]
|
–
|
–
|
–
|
+
|
–
|
–
|
+/-
|
–
|
CXCL1
|
Mild anemia, Neutrophilia
|
↑
|
Factor V Leiden
|
Focal CNS lesions
|
Aneurysm formation and thrombosis areas
|
Valve vegetations and ventricular thrombi in echocardiography
|
Meningoencephalitis in MRI
|
Lymphocytic and plasma cell invasion in the prickle cell layer of the epidermis
|
Clinical criteria
|
Genital ulcerations, Oral ulceration
|
| Cogan’s syndrome[59]
|
+/-
|
–
|
–
|
+/-
|
–
|
–
|
–
|
+
|
Anti-Hsp70 antibodies
|
Anemia, Thrombocytosis
|
↑
|
RF, ANA
|
Thickening and enhancement of both posterior sclera
|
Stenosis, thrombosis or more lesions in aortic root
|
Aortic insufficiency in echocardiography
|
Early interstitial keratitis by slit lamp
|
Muscle necrosis and atrophy resembling myositis
|
–
|
Red eye, Hearing loss, Vertigo
|
| Gastrointestinal disease
|
Inflammatory Bowel Disease[60]
|
+/-
|
+
|
+
|
+
|
+
|
–
|
–
|
–
|
Anti-Saccharomyces cerevisiae antibody (ASCA), P-ANCA
|
Leukocytosis, Anemia
|
↑
|
Iron or vitamin deficiency, Stool OB
|
Mesenteric fat stranding, bowel wall enhancement, increased vascularity (comb sign)
|
–
|
Fistulas, Abscesses, Stenosis
|
Grossly denuded mucosa with active bleeding in colonoscopy
|
Crypt abscesses and mucosal ulceration, Granulomas
|
Endoscopy
|
GI bleeding
|
| Whipple’s disease[61]
|
+
|
+/-
|
+
|
+
|
+
|
+
|
+
|
+
|
CCR6, Gut-homing marker integrin β7-chain, T whippelii DNA
|
Mild anemia, Neutrophilia
|
↑
|
72-hour fecal fat determination
|
Nonspecific malabsorption
|
–
|
Hepatosplenomegaly
|
–
|
Periodic acid-Schiff–positive macrophages infiltration in lamina propria of the small bowel
|
Broad-spectrum PCR amplifications
|
Cachexia,
Glossitis
|
| Sjögren’s syndrome[62]
|
–
|
–
|
+/-
|
+
|
–
|
–
|
–
|
–
|
Anti-Ro and Anti-La, Anti-alpha-fodrin antibody
|
Anemia,
Leukopenia,
Eosinophilia
|
↑
|
Hypergammaglobulinemia, Low bicarbonate level, Hypokalemia
|
Salt and pepper or honeycomb appearance in parotid glands
|
–
|
Multicystic or reticular pattern in atrophic salivary gland
|
R/O obstructions or strictures with Sialography
|
Focal aggregates of lymphocytes
|
Schirmer test
|
Keratoconjunctivitis, Gingival inflammation
|
| Single-organ vasculitis
|
Primary central nervous system vasculitis[63]
|
+
|
+
|
+
|
–
|
+
|
–
|
+
|
+
|
von Willebrand factor antigen (vWF)
|
Normal
|
–
|
CSF pleocytosis, predominantly lymphocytes
|
Cerebral infarcts or hemorrhages with mass effect, or hydrocephalus
|
Aneurysm in circle of Willis
|
–
|
Progression of the disease or response to therapy in MRI
|
Chronic granulomatous inflammation and giant cells
|
Histological confirmation
|
Skin rash, Purpura
|
| Infectious disease
|
Aspergillosis[64]
|
+
|
+
|
+
|
–
|
–
|
–
|
–
|
+
|
Aspergillus nucleic acid in blood, Galactomannan
|
Eosinophilia
|
↑
|
↑Serum IgE
|
Aspergilloma mass within a cavity
|
Mass effect stenosis
|
–
|
Aspergilloma mass within the brain in MRI
|
Septate hyphae, branching at acute angles, and tissue necrosis with granulomata and blood vessel invasion
|
Histological confirmation
|
Hemoptysis, Aspergilloma
|
| Histoplasmosis[65]
|
+
|
+
|
+
|
+
|
+
|
–
|
–
|
+
|
–
|
Mild anemia
|
↑
|
↑ALP, ↑LDH
|
Cerebral histoplasmosis
|
–
|
Valvular involvement in echocardiography
|
PFT
|
Presence of yeast forms in tissue through hematoxylin and eosin staining
|
Sputum cultures
|
Pneumonia, Mediastinitis
|
| Herpes Simplex Encephalitis[66]
|
+
|
+
|
–
|
–
|
–
|
–
|
–
|
+
|
HSV DNA
|
Mild lymphocytosis
|
↑
|
CSF pleocytosis
|
Low-density lesions in the temporal and/or frontal lobe
|
–
|
–
|
Hemorrhagic lesion in white matter
|
Multinuclear giant cells
|
PCR or brain biopsy
|
Seizures,
Vomiting
|
| Systemic disease
|
Eclampsia[67]
|
+
|
+
|
–
|
+
|
–
|
–
|
+
|
+
|
VEGF, PlGF, Soluble FLT-1
|
Anemia, Thrombocytopenia, Schistocytes
|
–
|
↑Bilirubin, ↓Haptoglobin, ↑LDH, ↑Cr
|
Cortical hypodense areas in the occipital lobes, Diffuse cerebral edema
|
–
|
Poor fetal growth, Oligohydramnios, Abnormal umbilical artery
|
Increased signal at the gray-white matter junction in MRI
|
–
|
24-hour urine study
|
Seizure, Edema
|
| Fibromuscular dysplasia[6]
|
+
|
–
|
+/-
|
+
|
+
|
+
|
+
|
+/-
|
Transforming growth factor β (TGF-β)
|
Normal
|
↑
|
↑ Cr or BUN
|
Alternating stenosis and dilatations in CT angiography
|
Stenosis in the renal arteries
|
Luminal narrowing alternating with dilatation (Beads sign)
|
Focal concentric, long-segment tubular stenosis or outpouching in MRA
|
Fibrodysplastic changes, Collagen deposition
|
Digital subtraction angiography (DSA)
|
Spontaneous coronary artery dissection (SCAD)
|
References
- ↑ Vaideeswar P, Deshpande JR (2013). “Pathology of Takayasu arteritis: A brief review”. Ann Pediatr Cardiol. 6 (1): 52–8. doi:10.4103/0974-2069.107235. PMC 3634248. PMID 23626437.
- ↑ Calvo-Romero JM (2003). “Giant cell arteritis”. Postgrad Med J. 79 (935): 511–5. PMC 1742823. PMID 13679546.
- ↑ Stafa A, Leonardi M (2008). “Role of neuroradiology in evaluating cerebral aneurysms”. Interv Neuroradiol. 14 Suppl 1: 23–37. doi:10.1177/15910199080140S106. PMC 3328052. PMID 20557771.
- ↑ Cassiman C, Casteels I, Stalmans P, Legius E, Jacob J (2017). “Optical Coherence Tomography Angiography of Retinal Microvascular Changes Overlying Choroidal Nodules in Neurofibromatosis Type 1”. Case Rep Ophthalmol. 8 (1): 214–220. doi:10.1159/000469702. PMC 5422752. PMID 28512424.
- ↑ Evans, D G. R (2000). “Neurofibromatosis type 2”. Journal of Medical Genetics. 37 (12): 897–904. doi:10.1136/jmg.37.12.897. ISSN 1468-6244.
- ↑ 6.0 6.1 Plouin PF, Perdu J, La Batide-Alanore A, Boutouyrie P, Gimenez-Roqueplo AP, Jeunemaitre X (2007). “Fibromuscular dysplasia”. Orphanet J Rare Dis. 2: 28. doi:10.1186/1750-1172-2-28. PMC 1899482. PMID 17555581.
- ↑ Gazit Y, Jacob G, Grahame R (2016). “Ehlers-Danlos Syndrome-Hypermobility Type: A Much Neglected Multisystemic Disorder”. Rambam Maimonides Med J. 7 (4). doi:10.5041/RMMJ.10261. PMC 5101008. PMID 27824552.
- ↑ Michet CJ, Matteson EL (2008). “Polymyalgia rheumatica”. BMJ. 336 (7647): 765–9. doi:10.1136/bmj.39514.653588.80. PMC 2287267. PMID 18390527.
- ↑ Baker KR, Rice L (2012). “The amyloidoses: clinical features, diagnosis and treatment”. Methodist Debakey Cardiovasc J. 8 (3): 3–7. PMC 3487569. PMID 23227278.
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