Temporal arteritis other diagnostic studies

Temporal Arteritis Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2]

Overview

The gold standard for diagnosing temporal arteritis is biopsy, which involves removing of a small part of the vessel and examining it microscopically for giant cells infiltrating the tissue. Since the blood vessels are involved in a patchy pattern, there may be unaffected areas on the vessel and the biopsy might have been taken from these parts. So, a negative result does not definitely rule out the diagnosis.

[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].

Other Diagnostic Studies

• Temporal artery biopsy may be helpful in the diagnosis of temporal arteritis. Findings diagnostic of temporal arteritis include:[118][135]
  • skip lesions and normal intervening segments
  • Intimal thickening, with prominent cellular infiltration
  • Lymphocytes in the internal or external elastic lamina or adventitia
  • Areas of necrosis may be present in the arterial wall
  • Granulomas containing multinucleated histiocytic and foreign body giant cells, helper T-cell lymphocytes, plasma cells, and fibroblasts (7)

A positive TAB is diagnostic of GCA (100% specificity). The reported sensitivity of TAB has ranged widely, from as low as 15% to as high as 87%. [117] The histopathological changes on TAB often correlate with clinical features of severity. [11]

The reported chances of obtaining a positive biopsy after initiation of steroid treatment vary widely in the literature, from only 10% after 1 week to 86% after 4 or more weeks of treatment. [118, 119]

most physicians with high clinical suspicion despite an initial negative biopsy would still recommend a second contralateral biopsy, given the consequences of a missed diagnosis of GCA. [124]

TAB is a safe procedure; however, risks include temporary or permanent damage to the temporal branch of the facial nerve, infection, bleeding, hematoma, and dehiscence. Isolated case reports exist of ischemic stroke or skin ulceration from disruption of collateral flow from an asymptomatic carotid occlusion.

• Other diagnostic studies for [disease name] include:
  • [Diagnostic study 1], which demonstrates:
    • [Finding 1]
    • [Finding 2]
    • [Finding 3]