Churg-Strauss syndrome diagnostic study of choice: Difference between revisions
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== Diagnostic Study of Choice == | == Diagnostic Study of Choice == | ||
*High resolution CT scan: | *High resolution CT scan:<ref name="pmid20623310">{{cite journal |vauthors=Szczeklik W, Sokołowska B, Mastalerz L, Grzanka P, Górka J, Pacułt K, Miszalski-Jamka T, Soja J, Musiał J |title=Pulmonary findings in Churg-Strauss syndrome in chest X-rays and high resolution computed tomography at the time of initial diagnosis |journal=Clin. Rheumatol. |volume=29 |issue=10 |pages=1127–34 |date=October 2010 |pmid=20623310 |doi=10.1007/s10067-010-1530-3 |url=}}</ref><ref name="pmid15818205">{{cite journal |vauthors=Silva CI, Müller NL, Fujimoto K, Johkoh T, Ajzen SA, Churg A |title=Churg-Strauss syndrome: high resolution CT and pathologic findings |journal=J Thorac Imaging |volume=20 |issue=2 |pages=74–80 |date=May 2005 |pmid=15818205 |doi= |url=}}</ref><ref name="pmid21496416">{{cite journal |vauthors=Feng RE, Xu WB, Shi JH, Mahmoudi A, Mu WB, Zheng WJ, Zhu YJ, Liu HR |title=Pathological and high resolution CT findings in Churg-Strauss syndrome |journal=Chin. Med. Sci. J. |volume=26 |issue=1 |pages=1–8 |date=March 2011 |pmid=21496416 |doi= |url=}}</ref> | ||
**[[High-resolution CT|High-resolution computerized tomography]] ([[High Resolution CT|HRCT]]) scan of patients with [[eosinophilic granulomatosis with polyangiitis]] will show the following findings: | **[[High-resolution CT|High-resolution computerized tomography]] ([[High Resolution CT|HRCT]]) scan of patients with [[eosinophilic granulomatosis with polyangiitis]] will show the following findings: | ||
*** Airspace consolidations mostly bilateral and lobular distribution | *** Airspace consolidations mostly bilateral and lobular distribution | ||
*** Ground-glass opacities, can be seen in a patchy or subpleural distribution, with inclination most commonly occurring in the lower zone portion of the lung | *** Ground-glass opacities, can be seen in a patchy or subpleural distribution, with inclination most commonly occurring in the lower zone portion of the [[lung]] | ||
*** Centrilobular nodules | *** Centrilobular nodules | ||
*** Bronchial wall thickening and/or dilatation | *** Bronchial wall thickening and/or dilatation | ||
*** Pleural effusions | *** [[Pleural effusion|Pleural effusions]] | ||
*** Hilar or mediastinal lymph node enlargement | *** Hilar or [[mediastinal lymph node]] enlargement | ||
*** Interlobular septal thickening | *** Interlobular septal thickening | ||
*Biopsy | *Biopsy | ||
**Because of the multiple organ involvements, the biopsy should be obtained from any of the following organ sites: | **Because of the multiple organ involvements, the biopsy should be obtained from any of the following organ sites: | ||
***Lung: | ***[[Lung]]:<ref name="pmid7952571">{{cite journal| author=Allen JN, Davis WB| title=Eosinophilic lung diseases. | journal=Am J Respir Crit Care Med | year= 1994 | volume= 150 | issue= 5 Pt 1 | pages= 1423-38 | pmid=7952571 | doi=10.1164/ajrccm.150.5.7952571 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7952571 }} </ref> | ||
****The gold standard in establishing a diagnosis for eosinophilic granulomatosis with polyangiitis is a lung biopsy. surgical or transbronchial biopsy can be performed. | ****The gold standard in establishing a diagnosis for eosinophilic granulomatosis with polyangiitis is a lung biopsy. surgical or transbronchial biopsy can be performed. | ||
***Skin | ***[[Skin]] | ||
***Nerve | ***[[Nerve]] | ||
***Kidney | ***[[Kidney]] | ||
***Muscle | ***[[Muscle]] | ||
**Biopsy findings may include | **[[Biopsy]] findings may include infiltration by [[Eosinophil granulocyte|eosinophils]], vasculitis of small and medium-sized vessels and granuloma formation. | ||
=== Diagnostic Criteria === | === Diagnostic Criteria === | ||
Latest revision as of 20:46, 12 April 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chandrakala Yannam, MD [2]
Overview
There are no specific diagnostic studies to confirm the diagnosis of eosinophilic granulomatosis with polyangiitis, High resolution CT scan of lung and biopsy from various organs may be helpful in confirming the disease.
Diagnostic Study of Choice
- High resolution CT scan:[1][2][3]
- High-resolution computerized tomography (HRCT) scan of patients with eosinophilic granulomatosis with polyangiitis will show the following findings:
- Airspace consolidations mostly bilateral and lobular distribution
- Ground-glass opacities, can be seen in a patchy or subpleural distribution, with inclination most commonly occurring in the lower zone portion of the lung
- Centrilobular nodules
- Bronchial wall thickening and/or dilatation
- Pleural effusions
- Hilar or mediastinal lymph node enlargement
- Interlobular septal thickening
- High-resolution computerized tomography (HRCT) scan of patients with eosinophilic granulomatosis with polyangiitis will show the following findings:
- Biopsy
- Because of the multiple organ involvements, the biopsy should be obtained from any of the following organ sites:
- Biopsy findings may include infiltration by eosinophils, vasculitis of small and medium-sized vessels and granuloma formation.
Diagnostic Criteria
According to the American College of Rheumatology classification criteria [5]
| Asthma
Polyneuropathy or Mononeuropathy Non fixed pulmonary infiltrates Paranasal sinus that is abnormal Eosinophils that are extravascular |
Patients must express 4 out the 6 criteria to be diagnosed with eosinophilic granulomatosis with polyangiitis. |
According to Lanham diagnostic criteria [6]
| Asthma
Eosinophilia peak of >1.5x109 cell/L or >10% of the total WBC Systemic vasculitis, two or greater extra pulmonary sites |
All 3 criteria’s need to be present |
References
- ↑ Szczeklik W, Sokołowska B, Mastalerz L, Grzanka P, Górka J, Pacułt K, Miszalski-Jamka T, Soja J, Musiał J (October 2010). "Pulmonary findings in Churg-Strauss syndrome in chest X-rays and high resolution computed tomography at the time of initial diagnosis". Clin. Rheumatol. 29 (10): 1127–34. doi:10.1007/s10067-010-1530-3. PMID 20623310.
- ↑ Silva CI, Müller NL, Fujimoto K, Johkoh T, Ajzen SA, Churg A (May 2005). "Churg-Strauss syndrome: high resolution CT and pathologic findings". J Thorac Imaging. 20 (2): 74–80. PMID 15818205.
- ↑ Feng RE, Xu WB, Shi JH, Mahmoudi A, Mu WB, Zheng WJ, Zhu YJ, Liu HR (March 2011). "Pathological and high resolution CT findings in Churg-Strauss syndrome". Chin. Med. Sci. J. 26 (1): 1–8. PMID 21496416.
- ↑ Allen JN, Davis WB (1994). "Eosinophilic lung diseases". Am J Respir Crit Care Med. 150 (5 Pt 1): 1423–38. doi:10.1164/ajrccm.150.5.7952571. PMID 7952571.
- ↑ Masi AT, Hunder GG, Lie JT, Michel BA, Bloch DA, Arend WP; et al. (1990). "The American College of Rheumatology 1990 criteria for the classification of Churg-Strauss syndrome (allergic granulomatosis and angiitis)". Arthritis Rheum. 33 (8): 1094–100. PMID 2202307.
- ↑ Lanham JG, Elkon KB, Pusey CD, Hughes GR (1984). "Systemic vasculitis with asthma and eosinophilia: a clinical approach to the Churg-Strauss syndrome". Medicine (Baltimore). 63 (2): 65–81. PMID 6366453.