Diagnosis of Takayasu's disease

Diagnosis of Takayasu's disease is based on typical clinical signs and instrumental research data.

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

Criteria	Clarification
Pulseless syndrome	Asymmetry of pulse and blood pressure (more than 10 mm Hg) in the extremities, absence of pulse in one or two radial or other arteries
Instrumental confirmation of pathology of the aorta and large arteries	Deformation - stenosis, aneurysms of the arch, descending and abdominal aorta and/or the area of the mouth or proximal parts of the arteries branching off from it
Pathological vascular noises	Harsh murmurs detected during auscultation over the carotid, subclavian, femoral arteries, and abdominal aorta
Intermittent claudication syndrome	Asymmetrical pain and fatigue in the distal leg muscles that occurs with exertion
Arterial hypertension syndrome	Development of persistent increase in blood pressure during the course of the disease
Increased ESR	Persistent increase in ESR over 33 mm/h for over 3 months

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

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Clinical diagnosis of Takayasu's disease

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

In the case of non-specific aortoarteritis, careful examination, palpation of the pulse and measurement of blood pressure in the arms and legs, auscultation along the aorta and over the main arteries (subclavian, carotid, femoral), comparison of clinical symptoms with the possible localization of vascular damage, as well as the results of instrumental studies allow verification of a previously undetermined diagnosis.

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Laboratory diagnostics of Takayasu's disease

General blood analysis. In the acute phase, moderate anemia, neutrophilic leukocytosis, and increased ESR (40-70 mm/h) are determined.

Biochemical blood test. In case of renal vascular damage in case of renal failure, an increase in the level of nitrogenous waste and potassium in the blood serum is detected.

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

General urine analysis. Transient proteinuria is possible.

Instrumental diagnostics of Takayasu's disease

ECG. In case of damage to the coronary arteries, ischemic changes in the myocardium may be detected.

EchoCG. In case of damage to the ascending aorta, an increase in the diameter of the lumen of the affected section of the aorta and uneven thickening of the wall are determined. With a significant increase in the lumen of the aorta, relative insufficiency of the aortic valve may be observed.

Ultrasound of the kidneys. In case of renal artery damage, it is possible to visualize changes in the renal artery and detect changes in the size of the kidney.

Dopplerography. Duplex scanning is the most convenient method for detecting vascular lesions in nonspecific aortoarteritis. It is indispensable in the early stages of the disease, noninvasive and allows not only to visualize the vessel, but also to simultaneously evaluate the linear and volumetric blood flow velocity, the resistance index.

CT allows us to assess the thickness of the vascular wall, visualize aneurysms, including dissecting ones, and formed thrombi,

X-ray contrast angiography provides reliable information about obliterating arterial disease, vessel wall structure and lesion topic. It is used in cases where surgical intervention is planned.

Differential diagnosis of Takayasu's disease

Differential diagnostics are carried out in the initial period with rheumatism, Henoch-Schonlein disease, nodular polyarteritis, other rheumatic diseases, and congenital pathology of the main vessels.

In rheumatism, in contrast to non-specific aortoarteritis, asymmetric transient volatile polyarthritis is observed. Heart failure usually develops with repeated attacks against the background of heart disease or current endocarditis.

In contrast to Henoch-Schonlein disease, the hemorrhagic rash in nonspecific aortoarteritis is located asymmetrically, combined with polymorphic elements, cardiovascular symptoms; abdominal pain develops not in the first days of the disease, but after several months.

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

When pulse and blood pressure asymmetry is detected, and deformation of the aorta and its branches is revealed using auxiliary instrumental methods, Takayasu's disease is differentiated from congenital pathology of the main vessels, which is not characterized by prolonged fever, muscle and joint pain, rash, visual impairment, or abdominal pain. Congenital deformation of the aorta is usually clinically asymptomatic.

Aortitis occurs as a rare manifestation of some rheumatic diseases - rheumatism, rheumatoid arthritis, seronegative spondyloarthritis, Behcet's disease. In addition to the typical clinical picture, the localization of the lesion is also taken into account in differential diagnostics. In the listed diseases, inflammatory changes extend only to the proximal part of the aortic arch, in some cases aortic valve insufficiency is formed.

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