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Vascular and/or Interventional Radiology

E2644. Visceral Vasculitis and Radiological Manifestations

Ramjit A,  Mehta V,  Peti S. Staten Island University Hospital, Staten Island, NY

Address correspondence to A. Ramjit (aramjit1@northwell.edu)

Background Information: Vasculitides are characterized by vessel wall inflammation and necrosis that can be broadly divided into large, medium, and small vessel vasculitides. These vasculitides encompass a broad range of unique as well as overlapping clinical, imaging and pathophysiological feature. This educational exhibit aims to discuss various vasculitides in an organized fashion to highlight their clinical, pathophysiologic and imaging characteristics.

Educational Goals/Teaching Points: We discuss the various vasculitides involving the visceral arteries; classify the vasculitides, including systemic lupus erythematosus (SLE), polyarteritis nodosa, Henoch-Schönlein, Behçet disease, and Takayasu arteritis; and illustrate the various imaging findings and pathophysiological characteristics of various vasculitides.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: Blood vessels of all sizes are affected by vasculitis that is characterized by necrosis and inflammation of the vessels. The location and the size of the vessels involved correlate with the clinical symptoms. These vasculitides are broadly divided as large, medium or small vessel diseases based on the size of the predominantly effected vessels. Examples include Takayasu arteritis, polyarteritis nodosa and SLE as entities involving large, medium and small vessels respectively. The underlying pathological mechanism and cause of these vasculitides is variable and diagnosis is generally difficult to make on imaging findings alone. However, characteristic imaging features of these entities provide diagnostic clues. Additionally, recognition of these imaging features along with an understanding of the underlying pathophysiology allow radiologists to anticipate implications of a particular entity on overall vascular and extravascular manifestations when considering further work up or vascular intervention. For example, Takayasu arteritis involves the larger to medium sized vessels and may demonstrate areas of irregular arterial wall narrowing and thickening, poststenotic dilatations, flow dynamic changes, and increased collateralization on multiple imaging modalities. Polyarteritis nodosa affects the medium to small vessels and is characteristically associated with multiple aneurysms with segmental arterial wall weakening. Disease progression most commonly occurs at the renal and GI arteries to produce clinical symptoms. SLE involves the small vessels, routinely involving the GI tract vasculature with imaging features including comblike arrangement of engorged mesenteric vessels, findings of focal or diffuse bowel wall thickening, lymphadenopathy, and abnormal bowel wall enhancement pattern.

Conclusion: Visceral vasculature is commonly affected by the various vasculitides presenting with certain characteristic imaging and clinical findings. An understanding of the imaging findings and pathophysiological features is essential to make the appropriate diagnosis in the proper clinical setting. This educational exhibit aims to present the clinical, pathophysiological and imaging characteristics of multiple small, medium and large vasculitides.