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LARGE VESSEL VASCULITIS
Authored By: Henry Royal and Jonathan Weiss.
Patient: 72 year old female
History:

Patient presents with bilateral upper extremity weakness and hand paresthesias for 6 weeks.

Image Size:[small][as-submitted]

Multimedia: 206891_1_submitted.avi

Fig. 2
Coronal PET images

Fig. 3
MRI MIP image
Image Size:[small][as-submitted]

Findings:

RADIOPHARMACEUTICAL: 14.9 mCi F-18 Fluorodeoxyglucose i.v.

There is symmetric, homogeneous, moderately increased FDG uptake diffusely in the subclavian, axillary, and proximal brachial arteries.  Additionally, there is a short segment of moderately increased uptake in the left common iliac artery.

MRI:  There is bilateral long segment severe stenosis of the axillary arteries with symmetric occlusion at the level of the proximal brachial arteries.

Diagnosis:

Large vessel vasculitis

General Discussion:

Linear, contiguous FDG uptake similar to or greater than liver within the great vessels is typical for large vessel vasculitis.  Giant cell arteritis and Takayasu's arteritis can both involve the great vessels.  Takayasu’s arteritis typically affects younger patients (< 40 year old) whereas giant cell arteritis commonly affects patients over the age of 50.  Not uncommonly, patients are found to have large vessel vasculitis by PET during work up of fever of unknown origin.  In patients with large vessel vasculitis FDG uptake has been found to correlate with ESR and C-reactive protein levels.  FDG-PET has been shown to be useful in determining the degree and extent of disease in large vessel vasculitis.  FDG uptake can also be seen with atherosclerotic disease; however, it is typically less intense and is non-contiguous. 

References:

M. Walter, [18F]fluorodeoxyglucose PET in large vessel vasculitis, Radiol Clin North Am 45 (2007), pp. 735–744.

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Additional Details:

Case Number: 206891Owner(s): Henry Royal and Jonathan WeissLast Updated: 12-07-2011
Anatomy: Cardiopulmonary   Pathology: Non-Infectious Inflammatory Disease
Modality: MR, PETAccess Level: Readable by all users, writable by NucMed Certifiers
Keywords: vasculitis, ptnm

Case has been viewed 34 times.
Certified by Henry Royal on 09-17-2009

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