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What is the role of tissue biopsy in the diagnosis of vasculitis and in what type of vasculitis might tissue biopsy be helpful?
Tissue biopsy is unquestionably the procedure of choice in the diagnosis of vasculitis. Some frequently biopsied sites are as follows:
• Common sites: skin (diagnostic for IgA vasculitis), sural nerve (PAN, EGPA; only biopsy if abnormal EMG/NCV), temporal artery (GCA), muscle (PAN), kidney (GPA, MPA; rare to see vasculitis, usually see focal necrotizing glomerulonephritis with or without crescents), lung (GPA, MPA)
• Less common sites: testicle (PAN), rectum/gut, liver, heart, brain. (primary CNS vasculitis), sinus (GPA).
If tissue biopsy is not feasible, what alternative procedures can yield a diagnosis?
Angiography (formal or CT angiography) of the following sites may be helpful for diagnosis of certain types of vasculitis:
- • Abdomen (celiac trunk, superior mesenteric, and renal arteries) for diagnosis of PAN.
- • Aortic arch for diagnosis of Takayasu arteritis and GCA with large-vessel involvement.
- • Extremities for diagnosis of Buerger disease.
- • Cerebral sites for diagnosis of primary CNS vasculitis.
