Page 54 - The Vasculitides Volumes 2

30 Adam J. Davis and David S. Younger

Figure Legends

Figure 1 (a-g). Takayasu Arteritis and collateral circulation in two patients, both with vascular insufficiency.
Patient 1: figures 1a-f; Patient 2: 1g. (a and b) Complete occlusion of the great vessels arising from the aortic
arch on CA and CTA with residual stumps of the brachiocephalic, common carotid and left subclavian
arteries (black arrows). (c) Extensive collaterals to the cephalic circulation via the intercostal arteries (black
arrows) to the deep cervical and vertebral artery (black arrowheads). (d) Distal deep cervical branches (black
arrows) with opacification of the occipital artery (black arrowhead) via retrograde flow filling the internal
carotid artery (black outline arrows). (e) Collateral circulation by CTA although flow dynamics are absent
(deep cervical artery, white arrows; occipital artery, white arrowheads; internal carotid artery, white outline
arrows). (f) Very small vasculature provides clinically significant collateral circulation employing CTA from
the ascending cervical artery, vertebral artery, and spinal radicular artery (white arrows) to the anterior spinal
artery (white arrowheads). (g) Isolated involvement of the left common carotid artery beginning at the origin
and extending the length of the vessel. Note the severe continuous long segment luminal narrowing
characteristic of the disease (g) Left, maximum intensity projection; middle, volume rendered image, outlined
white arrows). The internal and external carotid arteries imaged by CTA (right, volume rendered image,
outlined black arrows) are diminished in caliber with otherwise smooth lumina and normal morphology
resulting from decreased flow than the effect of vasculitic involvement. Abbreviations: CA, catheter
angiography; CTA, computed tomographic angiography. Courtesy of Adam Davis, M.D.

Figure 2 (a-c). Giant Cell Arteritis. Patient with severe worsening headache, diplopia and jaw pain. (a) At
presentation, MRA demonstrates multifocal luminal narrowing and contour irregularity within bilateral
internal carotid arteries (white arrows). (b) CTA volume rendering reveals multifocal short segment luminal
narrowing of the superficial temporal arteries (white arrows). (c) Maximum intensity projection images of the
internal carotid arteries with intraluminal linear defects (white arrows) are consistent with dissection.
Abbreviations: MRA, magnetic resonance angiography; CTA, computed tomographic angiography. Courtesy
of Adam Davis, M.D.

Figure 3 (a-d). Large vessel vasculitis with features of Takayasu arteritis and giant cell arteritis. (a) Marked
mural thickening with heterogeneous enhancement within the bilateral cervical vasculature shown left to
right: left subclavian, common carotid, and internal carotid arteries. The black arrows indicate the outer wall
contour, normally a barely imperceptible margin, while the white arrows indicate the enhancing, narrowed
vessel lumen with an appearance consistent with Takayasu arteritis. (b) CTA volume rendering with long
segment smooth narrowing of the left internal carotid artery (black arrow) with more localized narrowing
along the external carotid artery branches (arrowheads) typically found with giant cell arteritis. (c ) CTA
volume rendering narrowing of the superficial temporal artery (black arrow) as would be expected in giant
cell arteritis. (d) Resolution of mural thickening within the left subclavian, common carotid and internal
carotid arteries after treatment with corticosteroids. Abbreviations: CTA, computed tomographic
angiography. Courtesy of Adam Davis, M.D.

Figure 4 (a-e). Polyarteritis nodosa. (a) CA of the celiac axis performed five years prior to presentation with
multifocal luminal narrowing (black arrows) and aneurysmal dilatation (black arrowhead). (b and c) MRA
and CTA reveal a collection of prominent, tortuous vasculature at the posterior cervical space enveloping the
distal left vertebral artery. Prominent draining veins are noted (white arrows). (d) The left vertebral artery
(black arrow) is the site of arteriovenous shunting (black arrowhead) into a dilated, tortuous draining vein
confirming the diagnosis of an arteriovenous fistula. (e) CTA and CA (left and right respectively)
demonstrate a discrete region of luminal irregularity and narrowing within the proximal cervical segment of
the internal carotid artery (black arrows) which in isolation could be confused with fibromuscular dysplasia.
Abbreviations: CA, catheter angiography; MRA, magnetic resonance angiography; CTA, computed
tomographic angiography. Courtesy of Adam Davis, M.D.

Figure 5 (a-c). Eosinophilic granulomatosis with polyangiitis. (a) MRA of the limbs demonstrates multifocal
brachial, radial, posterior tibial and dorsalis pedis artery stenoses and occlusions. (b) MRI of the brain
(FLAIR right, ADC left) reveals a punctate right basal ganglia chronic lacunar infarct (black arrows). (c)
CTA of the brain demonstrates multifocal short and long segment luminal narrowing within the anterior
cerebral artery (black arrows), middle cerebral artery (white arrows) and superficial temporal artery (black
arrowheads). Intracranial vessels demonstrate marked luminal contour irregularity while the extracranial
arteries demonstrate a more long segment smooth and concentric narrowing, reflecting the variability of the

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