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

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 hemorrhages, cotton-wool exudates, venous dilatation and beading, microaneurysms of peripheral retina, optic atrophy, vitreous hemorrhage, wreathlike peripapillary arteriovenous anastomoses.

Physical Examination

A thorough physical examination is essential, with particular attention to:

• Peripheral pulses

• Blood pressure in all 4 extremities

• Ophthalmologic examination

Vital Signs

• Low-grade fever
• Hypertension
  • Due to renal artery involvement is found in approximately 50% of patients

• Absent or diminished pulses 

Skin

• Erythema nodosum

• Ulcerating nodular lesions

HEENT

Ophthalmologic examination may show:

• 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

• Carotid bruits

Lungs

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

Heart

• Heart murmurs
  • Aortic regurgitation may result from aortic root dilation

Abdomen

• Abdominal bruits

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:

• Lightheadedness

• Vertigo

• Syncope

• Orthostasis

• Headaches

• Convulsions

• Strokes

Extremities

• Femoral bruits
• Limb ischemia