Ultrasonography as a Diagnostic Support Tool for Childhood Takayasu Arteritis Referred to as Fever of Unknown Origin: Case Series and Literature Review

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  • Nozawa Hisataka
    Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
  • Ogura Masao
    Division of Pediatric Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
  • Miyasaka Mikiko
    Department of Radiology, National Center for Child Health and Development, Tokyo, Japan
  • Suzuki Hiromichi
    Department of Health Policy, National Research Institute for Child Health and Development, Tokyo, Japan
  • Ishikura Kenji
    Division of Pediatric Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
  • Ishiguro Akira
    Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
  • Ito Shuichi
    Division of Pediatric Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan

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Abstract

<p>Introduction: Childhood Takayasu arteritis (c-TA) often shows nonspecific symptoms, such as fever of unknown origin (FUO). Delay of diagnosis may result in organ dysfunction by arterial occlusion; therefore, early diagnosis is very important. Although ultrasonography is the first-line screening tool for children with FUO, its diagnostic efficacy of evaluation of systemic arteries in c-TA that presents as FUO remains unclear. We evaluated the suitability of ultrasonography evaluation that included systemic vessels for the early diagnosis of c-TA initially presenting as FUO.</p><p>Methods: We review five patients who received a diagnosis of c-TA in our institution and also performed a literature review regarding TA cases with FUO and diagnosed on the basis of initial ultrasonography.</p><p>Results: As in our cases, the median period from onset to diagnosis was 25 days (interquartile range [IQR], 21-35). Comparing the initial ultrasonography findings with later contrast-enhanced computed tomography (CECT) findings in the abdominal aorta, celiac artery, superior mesenteric artery, bilateral renal arteries, and bilateral common carotid arteries, the concordance rate between ultrasonography and CECT was moderate (Kappa coefficient was 0.50). All the patients were successfully treated without severe vascular damage. The literature review revealed 12 articles; although 9 of the 13 patients did not show the characteristic features (such as blood pressure discrepancy, bruit, or pulse deficiency), the median time to diagnosis was still 5 months (IQR, 3-12).</p><p>Conclusions: During initial screening for patients with FUO, ultrasonography including evaluation of systemic vessels could contribute to earlier diagnosis of c-TA.</p>

Journal

  • JMA Journal

    JMA Journal 4 (4), 358-366, 2021-10-15

    Japan Medical Association / The Japanese Associaiton of Medical Sciences

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