Vasculitis physical examination

Vasculitis
Overview
Classification Large-sized vessel vasculitis Takayasu's Arteritis Temporal Arteritis Medium-sized vessel vasculitis Kawasaki's Disease Polyarteritis Nodosa Small-sized vessel vasculitis Churg-Strauss Syndrome Cutaneous leukocytoclastic vasculitis Essential cryoglobulinemic vasculitis Henoch-Schonlein Purpura Microscopic polyangiitis Wegener's Granulomatosis Variable-sized vessel vasculitis Sjogren syndrome Cogan syndrome Single organ vasculitis Primary central nervous system angiitis
Causes
Differential Diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: M.Umer Tariq [2]

Physical Examination

Vitals

Temperature

• Elevated body temperature may be present (fever)

Pulse

Rate

• Tachycardia may be present

Strength

• Decreased pulsation of one or both brachial arteries - Takayasu arteritis
• Decreased pulsations in the temporal artery - Temporal arteritis

Blood Pressure

• At least 10 mmHg systolic difference in both arms - in Takayasu arteritis
• New onset diastolic blood pressure > 90 mmHg - Polyarteritis nodosa

Skin

• Palpable purpura - if patients have this in isolation, it is most likely due to cutaneous leukocytoclastic vasculitis. If the purpura is in combination with systemic organ involvement, it is most likely to be Henoch-Schonlein purpura or microscopic polyarteritis.
• Livedo reticularis - Polyarteritis nodosa
• Erythema of palms/soles, edema of hands/feet, periungual desquamation, polymorphous rash - Kawasaki disease
• Palpable purpura, maculopapular rash - Hypersensitivity vasculitis

Eye

• Bilateral conjunctival injection - Kawasaki disease

(Images courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA)

Skin:Leucocytolastic vasculitis; legs

Leucocytoclastic vasculitis; pustular type

Vasculitis: In this instance, the vasculitic skin lesions were secondary to Haemophilus endocarditis.

Vasculitis: In this instance, the vasculitic skin lesions were secondary to Haemophilus endocarditis.

Vasculitis: In this instance, idiopathic with palpable purpura.

Vasculitis: Palpable Purpura: Secondary to idiopathic leukocytoplastic vasculitis.

Vasculitis: In this instance, idiopathic.

Vasculitis: In this instance, idiopathic with palpable purpura.

Head

• Tenderness on the sides of the head - Temporal arteritis
• Tenderness on the head may be present in Takayasu arteritis
• Nasal or oral inflammation (oral ulcers or purulent/bloody nasal discharge, may be painful) - Wegener's granulomatosis
• Cervical lymphadenopathy (at least one node > 1.5 cm), injected or fissured lips, injected pharynx, or strawberry tongue - Kawasaki disease

Heart

Auscultation

• Bruit over one or both carotid arteries or abdominal aorta - Takayasu arteritis

Extremities

• Claudication

Neurologic

• Mononeuropathy or polyneuropathy - Polyarteritis nodosa, Churg-Strauss arteritis