Giant cell arteritis

Giant cell arteritis
Diagnosis in short
Giant cell arteritis. H&E stain.
Synonyms	temporal arteritis
LM	large artery with intramural inflammatory cells (often granulomatous); destruction of arterial wall, i.e. fibrinoid necrosis (pink anucleate arterial wall)
Site	large blood vessels - see vasculitides
Clinical history	patient older than 50 years
Signs	loss of vision, weight loss, chills, fever
Symptoms	jaw claudication (classic), headache (classic), double vision, scalp tenderness
Prevalence	uncommon
Blood work	ESR elevated
Prognosis	good if treated
Clin. DDx	other causes of headache
Treatment	steroids

Giant cell arteritis (abbreviated GCA), also known as temporal arteritis, is a type of large vessel vasculitis.

General

• Classically afflicts the temporal artery.

Clinical features:

• Classic finding: jaw claudication, in a patient older than 50 years.
• Other findings: headache, vision loss or diplopia, scalp tenderness, polymyalgia, weight loss, chills, fever.

Work-up:

• CRP, ESR, temporal artery biopsy.
  • ESR normal (>50 years old): <20 mm/hr males, <30 mm/hr females.

Treatment:

• Treat right away with high dose steroids.
  • Biopsy is confirmatory.

Microscopic

Features:

• Artery with intramural inflammatory cells.
  • Classically granulomatous inflammation.
    • Granulomas not required for the diagnosis!
• Destruction of arterial wall, e.g. fibrinoid necrosis (pink anucleate arterial wall).

Images

• 

  GCA - very low mag. (WC)

• 

  GCA - low mag. (WC)

• 

  GCA - intermed. mag. (WC)

• 

  GCA - high mag. (WC)

• 

  GCA - intermed mag. (WC)

• 

  GCA - high mag. (WC)

www:

• GCA (harvard.edu).
• GCA - several images (upmc.edu).

Sign out

Negative

TEMPORAL ARTERY, LEFT, BIOPSY:
- MEDIUM SIZE ARTERY WITHOUT PATHOLOGIC DIAGNOSIS, SEE COMMENT.

COMMENT:
A negative biopsy does not rule out the possibility of giant cell (temporal) 
arteritis, as this may be a focal disorder. The clinical management is 
dependent upon the clinical impression.

See also

• Vasculitides.
• Cardiovascular pathology.