E1953. Is it a Bird, a Plane, or Vasculitis in the Abdomen? A Review of Abdominal Manifestations of Systemic Vasculitides
University College Cork
Vasculitides are a subset of autoimmune conditions that are classified by their resulting inflammation of blood vessels. The inflammation can result in aneurysms, vasculature rupture, or even end-organ ischemia. Due to the extensive blood supply within the abdominal cavity, the presentation of abdominal vasculitis can vary from the involvement of large mesenteric blood vessels to small capillary blood vessels in the abdominal viscera.
Educational Goals / Teaching Points
This exhibit aims to outline the radiologic appearances of abdominal manifestations of systemic vasculitides, as well as to review the differential diagnoses of these entities. This exhibit also provides a resource for radiologists to aid recognition and diagnosis of vasculitides based on their appearance on abdominal imaging.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The most common vasculitides that can manifest as inflammation in the vasculature of the abdominal cavity will be discussed. These are classified based on the size of the vessel involved. Large vessel vasculitides include giant cell arteritis and Takayasu arteritis, which can present as inflammation of the abdominal aorta, celiac trunk, and surrounding bowel. Polyarteritis nodosa and Kawasaki disease are examples of medium vessel vasculitis that can present on imaging as dilation and dissection of the hepatic arteries and branches of the mesenteric vasculature. Small vessel vasculitides include granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, microscopic polyangiitis, and Henoch-Schonlein purpura. These can present with enhancement and thickening of the walls of the small bowel as well as inflammation of the kidneys and other organs and can present similarly to inflammatory bowel disease. Systemic lupus erythematosus and segmental arterial mediolysis are two more rare causes of vasculitis and can present as wall thickening, aneurysm, dissection, and hemorrhage of medium to large-sized vessels in the abdomen.
This exhibit was designed to review the radiological appearances of many of the systemic vasculitides in the abdominal cavity to aid in the recognition and diagnosis of these conditions alongside clinical presentation and laboratory investigations. It also serves as a guide to including vasculitis in the differential diagnosis when reporting on imaging with features similar to those discussed.