Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis by Mary A. Williamson Mt(ascp) Phd, L. Michael Snyder Md
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of the literature. Semin Arthritis Rheum. 2005;35:143–153.
KAWASAKI SYNDROME (MUCOCUTANEOUS LYMPH NODE SYNDROME)
Definition
Kawasaki syndrome is a variant of childhood polyarteritis of unknown etiology, with a high incidence of coronary artery complications.
Laboratory Findings
Histology: diagnosis is confirmed by histologic examination of the coronary artery (same as for polyarteritis nodosa).
Hematology: anemia (approximately 50% of patients). Leukocytosis (20,000–30,000/μL) with shift to left occurs during 1st week; lymphocytosis appears thereafter, peaking at the end of the 2nd week, and is a hallmark of this illness. Increased ESR.
CSF findings: increased mononuclear cells with normal protein and sugar.
Urinalysis: increased mononuclear cells; dipstick negative.
Joint fluid findings: increased white blood cell (WBC) count (predominantly PMNs) in patients with arthritis.
Core laboratory: laboratory changes due to AMI. Acute-phase reactants are increased (e.g., CRP, α-1-antitrypsin); these usually return to normal after 6–8 weeks.
TAKAYASU SYNDROME (ARTERITIS)
Definition
Takayasu syndrome is the term for granulomatous arteritis of the aorta. Temporal arteritis and rheumatic disease may also be associated with aortitis.
Greater incidence in young to middle-aged Asian females. Coronary involvement occurs in 15–25% of cases. Involvement is usually in segments and rarely diffuse.
Average age of onset is 24 years, and the diagnosis should be considered in individuals of <40 years with acute myocardial infarction.
Diagnosis is established by characteristic arteriographic narrowing or occlusion or histologic examination. Laboratory tests are not useful for diagnosis or to guide management.
Laboratory Findings
Findings are due to involvement of coronary or renal vessels.
Hematology: increased ESR is found in approximately 75% of cases during active disease but is normal in only 50% of cases during remission. WBC count is usually normal.
Core laboratory: serum proteins are abnormal, with increased γ globulins (mostly composed of IgM). Female patients have a continuous high level of urinary total estrogens (rather than the usual rise during the luteal phase after a low excretion during the follicular phase).
THROMBOANGIITIS OBLITERANS (BUERGER DISEASE)
Thromboangiitis obliterans is very rare and is the vascular inflammation and occlusion of medium and small arteries and veins of limbs; it is related to smoking and occurs mostly in males. Histology shows characteristic inflammatory and proliferative lesions. Coronary involvement is uncommon. Laboratory tests are usually normal.
INFECTIOUS (SECONDARY) VASCULITIS
Definition
Various microorganisms may cause vasculitis of any size vessel by either hematogenous spread or direct extension of cardiac structures involved (pericardium, valves).
Most important infections of the coronary arteries are syphilis, tuberculosis, and syphilitic arteritis.
Who Should Be Suspected?
Tuberculosis coronary arteritis occurs mainly in patients with preexisting pericardial or myocardial tuberculosis.
Syphilitic arteritis can involve the first 3–4 mm of the left and right coronary arteries with an obliterative arteritis.
When a nonviral infectious angiitis occurs, it is almost always accompanied by myocarditis with abscesses and pericarditis.
Laboratory Findings
Core lab blood work, cultures, and PCR analysis should be dictated by systemic clues to the underlying infectious process.
THROMBOPHLEBITIS, SEPTIC
Definition
Thrombophlebitis is vascular inflammation due to a blood clot.
Laboratory Findings
Findings are due to associated septicemia, complications (e.g., septic pulmonary infarction), and underlying disease.
Hematology: increased WBC count (often >20,000/μL), with marked shift to left and toxic changes in
KAWASAKI SYNDROME (MUCOCUTANEOUS LYMPH NODE SYNDROME)
Definition
Kawasaki syndrome is a variant of childhood polyarteritis of unknown etiology, with a high incidence of coronary artery complications.
Laboratory Findings
Histology: diagnosis is confirmed by histologic examination of the coronary artery (same as for polyarteritis nodosa).
Hematology: anemia (approximately 50% of patients). Leukocytosis (20,000–30,000/μL) with shift to left occurs during 1st week; lymphocytosis appears thereafter, peaking at the end of the 2nd week, and is a hallmark of this illness. Increased ESR.
CSF findings: increased mononuclear cells with normal protein and sugar.
Urinalysis: increased mononuclear cells; dipstick negative.
Joint fluid findings: increased white blood cell (WBC) count (predominantly PMNs) in patients with arthritis.
Core laboratory: laboratory changes due to AMI. Acute-phase reactants are increased (e.g., CRP, α-1-antitrypsin); these usually return to normal after 6–8 weeks.
TAKAYASU SYNDROME (ARTERITIS)
Definition
Takayasu syndrome is the term for granulomatous arteritis of the aorta. Temporal arteritis and rheumatic disease may also be associated with aortitis.
Greater incidence in young to middle-aged Asian females. Coronary involvement occurs in 15–25% of cases. Involvement is usually in segments and rarely diffuse.
Average age of onset is 24 years, and the diagnosis should be considered in individuals of <40 years with acute myocardial infarction.
Diagnosis is established by characteristic arteriographic narrowing or occlusion or histologic examination. Laboratory tests are not useful for diagnosis or to guide management.
Laboratory Findings
Findings are due to involvement of coronary or renal vessels.
Hematology: increased ESR is found in approximately 75% of cases during active disease but is normal in only 50% of cases during remission. WBC count is usually normal.
Core laboratory: serum proteins are abnormal, with increased γ globulins (mostly composed of IgM). Female patients have a continuous high level of urinary total estrogens (rather than the usual rise during the luteal phase after a low excretion during the follicular phase).
THROMBOANGIITIS OBLITERANS (BUERGER DISEASE)
Thromboangiitis obliterans is very rare and is the vascular inflammation and occlusion of medium and small arteries and veins of limbs; it is related to smoking and occurs mostly in males. Histology shows characteristic inflammatory and proliferative lesions. Coronary involvement is uncommon. Laboratory tests are usually normal.
INFECTIOUS (SECONDARY) VASCULITIS
Definition
Various microorganisms may cause vasculitis of any size vessel by either hematogenous spread or direct extension of cardiac structures involved (pericardium, valves).
Most important infections of the coronary arteries are syphilis, tuberculosis, and syphilitic arteritis.
Who Should Be Suspected?
Tuberculosis coronary arteritis occurs mainly in patients with preexisting pericardial or myocardial tuberculosis.
Syphilitic arteritis can involve the first 3–4 mm of the left and right coronary arteries with an obliterative arteritis.
When a nonviral infectious angiitis occurs, it is almost always accompanied by myocarditis with abscesses and pericarditis.
Laboratory Findings
Core lab blood work, cultures, and PCR analysis should be dictated by systemic clues to the underlying infectious process.
THROMBOPHLEBITIS, SEPTIC
Definition
Thrombophlebitis is vascular inflammation due to a blood clot.
Laboratory Findings
Findings are due to associated septicemia, complications (e.g., septic pulmonary infarction), and underlying disease.
Hematology: increased WBC count (often >20,000/μL), with marked shift to left and toxic changes in
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