Takayasu's arteritis physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Farnaz Khalighinejad, MD [2]
Overview
In a patient with Takayasu arteritis a thorough physical examination is essential, with particular attention to peripheral pulses, blood pressure in all 4 extremities, and ophthalmologic examination. The most common finding is pulseless upper extremities. Hypertension due to renal artery involvement is found in approximately 50% of patients. Absent or diminished pulses are the clinical hallmark of Takayasu arteritis, but pulses are normal in many patients and upper limbs are affected more often than lower limbs. Ophthalmologic examination may show retinal ischemia, retinal hemorrhages, cotton-wool exudates, venous dilatation and beading, microaneurysms of peripheral retina, optic atrophy, vitreous hemorrhage, and wreathlike peripapillary arteriovenous anastomoses.
Physical Examination
In a patient with Takayasu arteritis a thorough physical examination is essential, with particular attention to:[1][2]
- Peripheral pulses
- Blood pressure in all 4 extremities
- Ophthalmologic examination
Vital Signs
- Low-grade fever
- Hypertension (due to renal artery involvement which is found in approximately 50% of patients)
- Absent or diminished pulses
Skin
- Ulcerating nodular lesions
HEENT
Ophthalmologic examination may show:[3]
- Retinal ischemia
- Retinal hemorrhages
- Cotton-wool exudates
- Venous dilatation and beading
- Microaneurysms of peripheral retina
- Optic atrophy
- Vitreous hemorrhage
- Wreathlike peripapillary arteriovenous anastomoses (extremely rare)
Neck
Lungs
- Pulmonary examination of patients with Takayasu arteritis is usually normal.
Heart
- Heart murmurs
- Aortic regurgitation may result from aortic root dilation.
- Abdomen
Back
- Back examination of patients with Takayasu's arteritis is usually normal.
Genitourinary
- Genitourinary examination of patients with Takayasu's arteritis is usually normal.
Neuromuscular
- Involvement of the carotid and vertebral arteries causes decreased cerebral blood flow, leading to:
Extremities
References
- ↑ Kerr GS, Hallahan CW, Giordano J, Leavitt RY, Fauci AS, Rottem M, Hoffman GS (June 1994). "Takayasu arteritis". Ann. Intern. Med. 120 (11): 919–29. PMID 7909656.
- ↑ Mason JC (July 2010). "Takayasu arteritis--advances in diagnosis and management". Nat Rev Rheumatol. 6 (7): 406–15. doi:10.1038/nrrheum.2010.82. PMID 20596053.
- ↑ Hall S, Barr W, Lie JT, Stanson AW, Kazmier FJ, Hunder GG (March 1985). "Takayasu arteritis. A study of 32 North American patients". Medicine (Baltimore). 64 (2): 89–99. PMID 2858047.