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Large-vessel vasculitis mimics add difficulty to diagnoses


2 minutes

Jeffrey W. Olin, DO
Jeffrey W. Olin, DO

Rheumatologists commonly encounter large-vessel vasculitis, and in most circumstances there is effective treatment with agents that suppress the immune system. But the diagnosis of “vasculitis” is often used as a grab-bag term when the physician interpreting the imaging is not sure what the diagnosis is.

Jeffrey W. Olin, DO, Professor of Cardiovascular Medicine at Icahn School of Medicine at Mount Sinai and Director of Vascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Center for Cardiovascular Health in New York, will discuss the differences between vasculitis and non-inflammatory vascular diseases during the ACR Session Large-Vessel Vasculitis Mimics on Monday from 7:30 — 8:30 am in Room W375b.

“I see a large number of patients every year who are treated for vasculitis when what they had was a non-inflammatory vascular disease,” said Dr. Olin. “Because the use of these drugs to treat vasculitis may cause deleterious side effects and subject the patient to potential infection, it is important to recognize noninflammatory vascular disease for what it is and treat it appropriately.”

There are a number of non-inflammatory conditions encountered on CT angiography, MR angiography, or catheter-based angiography that may mimic vasculitis. The use of immunosuppressant agents will not only be ineffective in these situations but may actually be harmful. Fibromuscular dysplasia, spontaneous dissection of the carotid/vertebral/coronary/renal and visceral vessels and the less common segmental arterial mediolysis, or SAM, are often misdiagnosed as “vasculitis.”

“It is common for the radiologist who sees a dissection of a renal artery on imaging to suggest that this may be due to vasculitis and then the referring doctor, who may not be facile in interpreting the imaging, may treat the patient as if they have vasculitis,” Dr. Olin said. “In reality, spontaneous dissections are rarely due to vasculitis.

“Most of the vasculitis look-alikes have a distinct clinical phenotype and imaging features that allow the clinician to differentiate it from vasculitis,” Dr. Olin continued. “This session will help the rheumatologist learn how to distinguish between vasculitis, an inflammatory vascular disease, from these other conditions that are not inflammatory and should not be treated with potent immunosuppressant agents.”