Takayasu's arteritis physical examination: Difference between revisions

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<blockquote></blockquote>__NOTOC__
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{{Takayasu's arteritis}}
{{Takayasu's arteritis}}
{{CMG}} {{AE}} {{FKH}}
{{CMG}} {{AE}} {{FKH}}


==Overview==
==Overview==
A thorough physical examination is essential, with particular attention to peripheral pulses, blood pressure in all 4 extremities, ophthalmologic examination. The most common finding is a systolic blood pressure difference (>10 mm Hg) between arms. 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 [[hemorrhage]]<nowiki/>s, cotton-wool exudates, venous dilatation and beading, microaneurysms of peripheral retina, optic atrophy, vitreous hemorrhage, wreathlike peripapillary [[arteriovenous anastomoses]].  
In a patient with Takayasu arteritis a thorough [[physical examination]] is essential, with particular attention to peripheral [[Pulse|pulses]], [[blood pressure]] in all 4 extremities, and [[Ophthalmology|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 [[Pulse|pulses]] are the clinical hallmark of Takayasu arteritis, but [[Pulse|pulses]] are normal in many patients and upper limbs are affected more often than lower limbs. [[Ophthalmology|Ophthalmologic]] examination may show [[retinal ischemia]], retinal [[hemorrhage]]<nowiki/>s, [[Cotton-wool spot|cotton-wool]] [[Exudate|exudates]], venous dilatation and beading, [[Aneurysm|microaneurysms]] of peripheral [[retina]], [[optic atrophy]], [[vitreous hemorrhage]], and wreathlike peripapillary [[arteriovenous anastomoses]].


==Physical Examination==
==Physical Examination==
A thorough physical examination is essential, with particular attention to:
In a patient with Takayasu arteritis a thorough [[physical examination]] is essential, with particular attention to:<ref name="pmid7909656">{{cite journal |vauthors=Kerr GS, Hallahan CW, Giordano J, Leavitt RY, Fauci AS, Rottem M, Hoffman GS |title=Takayasu arteritis |journal=Ann. Intern. Med. |volume=120 |issue=11 |pages=919–29 |date=June 1994 |pmid=7909656 |doi= |url=}}</ref><ref name="pmid20596053">{{cite journal |vauthors=Mason JC |title=Takayasu arteritis--advances in diagnosis and management |journal=Nat Rev Rheumatol |volume=6 |issue=7 |pages=406–15 |date=July 2010 |pmid=20596053 |doi=10.1038/nrrheum.2010.82 |url=}}</ref>
* Peripheral pulses
* Peripheral [[Pulse|pulses]]


* Blood pressure in all 4 extremities  
* [[Blood pressure]] in all 4 extremities  


* Ophthalmologic examination
* [[Ophthalmology|Ophthalmologic]] examination
===Vital Signs===
* Low-grade [[fever]]
* [[Hypertension]] (due to [[renal artery]] involvement which is found in approximately 50% of patients)


===Appearance of the Patient===
* Absent or diminished [[Pulse|pulses]] 
===Vital Signs===
* Vital signs are with in normal limits.


===Skin===
===Skin===
* [[Erythema nodosum]]  
* [[Erythema nodosum]]  


* Ulcerating nodular lesions
* Ulcerating [[nodular lesions]]


===HEENT===
===HEENT===
Ophthalmologic examination may show:<ref name="pmid2858047">{{cite journal |vauthors=Hall S, Barr W, Lie JT, Stanson AW, Kazmier FJ, Hunder GG |title=Takayasu arteritis. A study of 32 North American patients |journal=Medicine (Baltimore) |volume=64 |issue=2 |pages=89–99 |date=March 1985 |pmid=2858047 |doi= |url=}}</ref>
[[Ophthalmology|Ophthalmologic]] examination may show:<ref name="pmid2858047">{{cite journal |vauthors=Hall S, Barr W, Lie JT, Stanson AW, Kazmier FJ, Hunder GG |title=Takayasu arteritis. A study of 32 North American patients |journal=Medicine (Baltimore) |volume=64 |issue=2 |pages=89–99 |date=March 1985 |pmid=2858047 |doi= |url=}}</ref>
* [[Retinal ischemia]]
* [[Retinal ischemia]]
* Retinal [[hemorrhage]]<nowiki/>s
* Retinal [[hemorrhage]]<nowiki/>s
* [[Cotton-wool spot|Cotton-wool]] exudates
* [[Cotton-wool spot|Cotton-wool]] [[Exudate|exudates]]
* Venous dilatation and beading
* Venous dilatation and beading
* Microaneurysms of peripheral retina
* Microaneurysms of peripheral [[retina]]
* [[Optic atrophy]]
* [[Optic atrophy]]
* [[Vitreous hemorrhage]]
* [[Vitreous hemorrhage]]
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===Neck===
===Neck===
* Neck examination of patients with Takayasu's arteritis is usually normal.
* [[Carotid bruits]]


===Lungs===
===Lungs===
* Pulmonary examination of patients with temporal arteritis is usually normal.
* Pulmonary examination of patients with Takayasu arteritis is usually normal.


===Heart===
===Heart===
* Heart murmurs
* [[Heart murmur|Heart murmurs]]
** Aortic regurgitation may result from aortic root dilation
** [[Aortic regurgitation]] may result from [[Aorta|aortic]] root dilation.
 
* Abdomen


===Abdomen===
* [[Abdominal bruit|Abdominal bruits]]
* Abdominal examination of patients with Takayasu's arteritis is usually normal.


===Back===
===Back===
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===Genitourinary===
===Genitourinary===
* Genitourinary examination of patients with Takayasu's arteritis is usually normal.
* [[Genitourinary system|Genitourinary]] examination of patients with Takayasu's arteritis is usually normal.


===Neuromuscular===
===Neuromuscular===
Involvement of the [[carotid]] and [[vertebral]] arteries causes decreased [[cerebral blood flow]], leading to:
* Involvement of the [[carotid]] and [[Vertebral artery|vertebral arteries]] causes decreased [[cerebral blood flow]], leading to:
* Lightheadedness
** [[Vertigo]]
 
** [[Syncope]]
* Vertigo
** [[Orthostasis]]
 
** [[Convulsions]]
* Syncope
** [[Strokes]]
 
* Orthostasis
 
* Headaches
 
* Convulsions
 
* Strokes


===Extremities===
===Extremities===
* [[Femoral artery|Femoral]] [[Bruit|bruits]]
* [[Pulselessness]]
* [[Limb ischemia]]


==References==
==References==
{{reflist|2}}
{{reflist|2}}


[[Category:Arthritis]]
[[Category:Medicine]]
[[Category:Rheumatology]]
[[Category:Rheumatology]]
[[Category:Disease]]
[[Category:Up-To-Date]]


{{WH}}
{{WH}}
{{WS}}
{{WS}}

Latest revision as of 13:42, 24 May 2018

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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 retinaoptic atrophyvitreous 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]

Vital Signs

Skin

HEENT

Ophthalmologic examination may show:[3]

Neck

Lungs

  • Pulmonary examination of patients with Takayasu arteritis is usually normal.

Heart

  • 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

Extremities

References

  1. 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.
  2. 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.
  3. 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.

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