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Rheumatology International

, Volume 39, Issue 2, pp 169–185 | Cite as

Diagnosis and differential diagnosis of large-vessel vasculitides

  • Gokhan KeserEmail author
  • Kenan Aksu
Review

Abstract

There are no universally accepted diagnostic criteria for large-vessel vasculitides (LVV), including giant cell arteritis (GCA) and Takayasu arteritis (TAK). Currently, available classification criteria cannot be used for the diagnosis of GCA and TAK. Early diagnosis of these two diseases is quite challenging in clinical practice and may be accomplished only by combining the patient symptoms, physical examination findings, blood test results, imaging findings, and biopsy results, if available. Awareness of red flags which lead the clinician to investigate TAK in a young patient with persistent systemic inflammation is helpful for the early diagnosis. It should be noted that clinical presentation may be highly variable in a subgroup of GCA patients with predominant large-vessel involvement (LVI) and without prominent cranial symptoms. Imaging modalities are especially helpful for the diagnosis of this subgroup. Differential diagnosis between older patients with TAK and this subgroup of GCA patients presenting with LVI may be difficult. Various pathologies may mimic LVV either by causing systemic inflammation and constitutional symptoms, or by causing lumen narrowing with or without aneurysm formation in the aorta and its branches. Differential diagnosis of aortitis is crucial. Infectious aortitis including mycotic aneurysms due to septicemia or endocarditis, as well as causes such as syphilis and mycobacterial infections should always be excluded. On the other hand, the presence of non-infectious aortitis is not unique for TAK and GCA. It should be noted that aortitis, other large-vessel involvement or both, may occasionally be seen in various other autoimmune pathologies including ANCA-positive vasculitides, Behçet’s disease, ankylosing spondylitis, sarcoidosis, and Sjögren’s syndrome. Besides, aortitis may be idiopathic and isolated. Atherosclerosis should always be considered in the differential diagnosis of LVV. Other pathologies which may mimic LVV include, but not limited to, congenital causes of aortic coarctation and middle aortic syndrome, immunoglobulin G4-related disease, and hereditary disorders of connective tissue such as Marfan syndrome and Ehler–Danlos syndrome.

Keywords

Vasculitis Large vessel Giant cell arteritis Temporal arteritis Takayasu Diagnosis Differential diagnosis Criteria Mimickers Aortitis 

Notes

Acknowledgements

The authors wish to thank Professor Dr. Suha Sureyya Ozbek, Head of Ege University Department of Radiology, for providing the ultrasound image.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no actual or potential conflict of interest in relation to this article.

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© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Rheumatology, Department of Internal MedicineEge University School of MedicineIzmirTurkey

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