Diagnosis of Takayasu's disease

Diagnosis of Takayasu disease is based on typical clinical signs and data from instrumental studies.

Classification criteria for nonspecific aortoarteritis (Takayasu's disease) in children

Criteria	Refinement
Syndrome of lack of pulse	Asymmetry of pulse and arterial pressure (more than 10 mm Hg) on limbs, absence of pulse on one or two radial or other arteries
Instrumental confirmation of pathology of the aorta and major arteries	Deformation - stenosis, aneurysms of the arch, descending and abdominal aorta and / or the area of the mouth or proximal areas of the arteries
Pathological vascular noise	Rough noises, determined during auscultation over the carotid, subclavian, femoral arteries, abdominal aorta
Intermittent claudication syndrome	Asymmetric pains and fatigue in the distal muscles of the legs that occur during exercise
Syndrome of arterial hypertension	Development of persistent increase in blood pressure during illness
Increased ESR	Persistent increase in ESR more than 33 mm / h over 3 months

The presence of 4 or more criteria is sufficient to establish a diagnosis.

[1], [2], [3], [4], [5], [6]

Clinical diagnosis of Takayasu's disease

In practice, the diagnosis of nonspecific aortoarteritis is usually established only when asymmetry (absence) of the pulse or blood pressure is detected, on the average - by the end of the second year of the disease. However, the observation shows the possibility of an earlier diagnosis provided that the orientation is in the search for a local circulation deficit in a girl (especially over 10 years old) with an increased ESR of an unknown cause.

In case of nonspecific aortoarteritis, close examination, palpation of the pulse and measurement of arterial pressure on the arms and legs, auscultation along the aorta and over the main arteries (subclavian, carotid, femoral), comparison of clinical symptoms with possible localization of vascular damage, and instrumental studies allow verifying before this is not an established diagnosis.

[7], [8], [9], [10], [11]

Laboratory diagnosis of Takayasu's disease

General blood analysis. In the acute phase, moderate anemia, neutrophilic leukocytosis, an increase in ESR (40-70 mm / h) is determined.

Blood chemistry. When lesions of kidney vessels in the case of renal failure, an increase in the level of nitrogenous slag and potassium serum is detected.

Immunological analysis of blood. In the acute phase, an increase in the content of the C-reactive protein is determined, and anticardiolipin antibodies can be detected.

General urine analysis. Transient proteinuria is possible.

Instrumental diagnosis of Takayasu's disease

ECG. Coronary artery disease can cause ischemic changes in the myocardium.

Echocardiography. When the ascending aorta is affected, an increase in the diameter of the lumen of the affected area of the aorta is determined, and the wall is unevenly thickened. With a significant increase in the aortic lumen, relative aortic valve failure may be noted.

Kidney ultrasound. With lesions of the renal artery, one can visualize changes in the renal artery and reveal changes in the size of the kidney.

Dopplerography. Duplex scanning is the most convenient technique for detecting vascular lesion in nonspecific aortoarteriitis. Indispensable in the early stages of the disease, non-invasive and allows not only to visualize the vessel, but also to assess in parallel the linear and volumetric flow velocity, the resistance index.

CT allows you to assess the thickness of the vascular wall, visualize aneurysms, including exfoliating, formed thrombus,

Radiocontrast angiography provides reliable information about the obliterating disease of the arteries, the structure of the vessel wall and the topography of the lesion. It is used when planning a surgical procedure.

Differential diagnosis of Takayasu's disease

Differential diagnosis is carried out in the initial period with rheumatism, Shenlaine-Henoch disease, nodular polyarteritis, other rheumatic diseases, congenital pathology of the main vessels.

In rheumatism, in contrast to nonspecific aortoarteritis, asymmetric transient volatile polyarthritis is noted. Heart failure develops usually with repeated attacks against a background of heart disease or current endocarditis.

In contrast to the Shenlaine-Henoch disease, hemorrhagic rash with unspecific aorto-arteritis is asymmetric, combined with polymorphic elements, cardiovascular symptoms; Pain in the abdomen does not develop in the first days of the disease, but in a few months.

Ultrasonic polyarteritis is not characterized by asymmetry or lack of pulse and arterial pressure, heart failure. At the same time, patients with Takayasu's disease do not observe such symptoms as nodules, livedo, necrosis of the skin and mucous membranes, polyneuritis.

When asymmetry of the pulse and arterial pressure is detected, the deformation of the aorta and its branches is revealed with the help of auxiliary instrumental methods, Takayasu's disease is differentiated from the congenital pathology of the main vessels, for which long-term fever, pain in the muscles and joints, rashes, visual impairment, and abdominal pain are not characteristic. Congenital deformity of the aorta is usually clinically asymptomatic.

Aortitis occurs as a rare manifestation of certain rheumatic diseases - rheumatism, rheumatoid arthritis, seronegative spondyloarthritis, Behcet's disease. In addition to the typical clinic, differential diagnosis also takes into account the localization of the lesion. With the listed diseases, inflammatory changes extend only to the proximal part of the aortic arch, in some cases, the aortic valve is inadequate.

[12], [13], [14], [15], [16]