Okay, here's the later. We've talked about the basic
that gives you way to think about how this happens,
how these happen, now we're talking about the specifics.
And each one of these vasculitides will have kind of a
will have different outcomes, will have different kind of
and those are the sorts of things they like to test on the
So, you have to kind of make a table and think your way
through all the little specifics,
because there are lots of little specifics.
So, giant cell aortitis and Takayasu's arteritis are
actually very similar.
In fact, identical in terms of their pathologic appearance.
They are a granulomatous, so a T cell driven vasculitis
of large to medium-sized vessels of the aorta and the main
An important point, and this is just an epidemiologic point,
they are identical histologically.
If you show me a slide of a giant cell aortitis in the aorta
and a slide of a Takayasu's aortitis or arteritis, I
couldn't tell them apart.
But epidemiologically, if someone has the same pathology in
a large vessel
and they're under the age of 50, we say it's Takayasu.
And if they are older than 50, we say they had giant cell.
That's the main difference. Takayasu's has classically been
associated with the Asian heritage.
It was originally described by Dr. Takayasu, but in fact, it
has a very global distribution.
It is not restricted to the Asian population.
These arteritis, Takayasu's and giant cell, are both more
common in women overall.
And we're just looking at examples. On the left-hand side is
a giant cell aortitis.
Giant cell aortitis tends to involve more of the aorta than
it does of the great vessels of the arch.
It tends to cause a thickening of the wall, and with damage
to the wall, we get dilation.
So, this is a dilated aorta with a thickened wall.
On the other hand, Takayasu arteritis tends to involve the
next levels down in size of the vessel.
So, it's not the aorta. It tends to involve the vessels of
the arch, the great vessels.
So, the innominate, subclavian, carotid, et cetera.
And you see on the right-hand side highlighted by a red oval
is an area
where we have relative stenosis there of the left subclavian
artery coming off on this patient.
There will also, in this particular case, appears to be left
carotid as well.
And there's less flow of the radiocontrast dye.
What does it look like? I'm showing you kind of normal on
the left-hand side.
It's a stain for elastic tissue, and slightly different
but the same elastic tissue stain.
The normal laminations in a normal aorta are well-layered
throughout and are uniform.
In a giant cell aortitis, there has been large scale
destruction of vast swaths of the media,
and destruction of the elastic tissue.
And we see at the margins of these areas of destruction,
granulomatous inflammation, giant cells, activated
There's going to be a lot of medial smooth muscle necrosis
as a result of the inflammatory cell recruitment.
And because now we have damage to the media, we're going to
have dilation of the vessel,
the response, including the activation of smooth muscle
because of the damage is that we will get intimal
a thickening and relative stenosis of the affected blood
In the aorta, not so much of a problem.
But in a subclavian artery, a big problem is that gets
and one of the other names for Takayasu's is pulseless
as we'll see in a subsequent slide.
So, science and symptoms of a Takayasu's arteritis, again,
going to be more likely to involve - not exclusively,
but more likely to involve the vessels of the arch, the
So, not specific symptomatic things due to cytokine
Systematically - systemically is going to be fever, malaise,
arthralgias, and night sweats.
These are nonspecific. The vascular symptoms, because of the
narrowing of the vessels,
that you get syncope. Patients will actually lose
They can also have involvement of the coronary arteries, so
they can get angina.
Because of the narrowing of the carotid, you will hear
So, if you put a stethoscope there, you'll hear a swooshing
and there will be a weak pulse depending on the degree of
stenosis due to the intimal hyperplasia.
Involvement of the ophthalmic arteries will give you visual
Because of the narrowing of the vessels going out to the
so the larger vessels, the subclavians for example, you'll
get a Raynaud's phenomena,
which is being demonstrated in the image on the right.
Skin manifestations include erythema nodosum.
So, nonspecific inflammatory consequences of having systemic
And as noted in the red box at the bottom,
Takayasu's arteritis is known as pulseless disease
because of the involvement of those large arch vessels.
Giant Cell Arteritis tends to have some
of the same systemic manifestations
fever, malaise, arthralgias, a night sweats
due to systemic cytokine elaboration.
Tthey may have back or
abdominal pain depending
on degree of involvement
of the aorta.
There is upper and lower extremity
claudication with pulse deficits.
This is less common than in
Takayasu's but can occur.
And again, although we talk about Takayasu
involving the great vessels of the arch,
giant cell arteritis
involving the aorta,
there's a lot of
overlap between the two.