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Images in Cardiovascular Medicine

High-Resolution Color-Coded Ultrasonography Findings of Subacute Temporal Arteritis With Ulcerating Skin Lesions

Lukas Kremmler, Karin Pfister, Sabine Bogdahn, Saida Zoubaa, Felix Schlachetzki
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https://doi.org/10.1161/CIRCULATIONAHA.114.009703
Circulation. 2014;130:348-349
Originally published July 21, 2014
Lukas Kremmler
From the Department of Neurology, University of Regensburg and Bezirksklinikum, Regensburg, Germany (L.K., F.S.); Vascular and Endovascular Surgery, University Hospital Regensburg, Germany (K.P,); Ophthalmology, Regensburg-Lappersdorf, Germany (S.B.); and Department of Neuropathology, University Hospital Regensburg, Germany (S.Z.).
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Karin Pfister
From the Department of Neurology, University of Regensburg and Bezirksklinikum, Regensburg, Germany (L.K., F.S.); Vascular and Endovascular Surgery, University Hospital Regensburg, Germany (K.P,); Ophthalmology, Regensburg-Lappersdorf, Germany (S.B.); and Department of Neuropathology, University Hospital Regensburg, Germany (S.Z.).
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Sabine Bogdahn
From the Department of Neurology, University of Regensburg and Bezirksklinikum, Regensburg, Germany (L.K., F.S.); Vascular and Endovascular Surgery, University Hospital Regensburg, Germany (K.P,); Ophthalmology, Regensburg-Lappersdorf, Germany (S.B.); and Department of Neuropathology, University Hospital Regensburg, Germany (S.Z.).
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Saida Zoubaa
From the Department of Neurology, University of Regensburg and Bezirksklinikum, Regensburg, Germany (L.K., F.S.); Vascular and Endovascular Surgery, University Hospital Regensburg, Germany (K.P,); Ophthalmology, Regensburg-Lappersdorf, Germany (S.B.); and Department of Neuropathology, University Hospital Regensburg, Germany (S.Z.).
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Felix Schlachetzki
From the Department of Neurology, University of Regensburg and Bezirksklinikum, Regensburg, Germany (L.K., F.S.); Vascular and Endovascular Surgery, University Hospital Regensburg, Germany (K.P,); Ophthalmology, Regensburg-Lappersdorf, Germany (S.B.); and Department of Neuropathology, University Hospital Regensburg, Germany (S.Z.).
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Introduction

An 86-year-old man presented with double vision and bitemporal ulcerative secreting skin lesions that had developed over the preceding 3 weeks (Figure A). His medical history included a 3-month episode of new headache and jaw claudication, and a common cardiovascular risk profile (cerebral ischemic stroke 10 years previously, hypertension, atrial fibrillation, and vascular surgery involving the aorta and right carotid artery), as well. The patient denied experiencing fever or weight loss; his drug regimen included antihypertensive, anticoagulant (phenprocoumon), and topical corticosteroid agents. Clinical examination revealed mild anisocoria and pallhypesthesia, resulting in a slight impairment in gait, and a prominent, indurated, but painless left superficial temporal artery (STA), as well.

High-resolution color duplex ultrasonography of the STA revealed an atypical echogenic endothelial layer and a periluminal hypoechogenic halo sign (Figure B and C). Extracranial ultrasonography identified moderate generalized arteriosclerosis. The erythrocyte sedimentation rate (ESR) was mildly elevated: 28 mm after 1 hour and 58 …

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July 22, 2014, Volume 130, Issue 4
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    High-Resolution Color-Coded Ultrasonography Findings of Subacute Temporal Arteritis With Ulcerating Skin Lesions
    Lukas Kremmler, Karin Pfister, Sabine Bogdahn, Saida Zoubaa and Felix Schlachetzki
    Circulation. 2014;130:348-349, originally published July 21, 2014
    https://doi.org/10.1161/CIRCULATIONAHA.114.009703

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    High-Resolution Color-Coded Ultrasonography Findings of Subacute Temporal Arteritis With Ulcerating Skin Lesions
    Lukas Kremmler, Karin Pfister, Sabine Bogdahn, Saida Zoubaa and Felix Schlachetzki
    Circulation. 2014;130:348-349, originally published July 21, 2014
    https://doi.org/10.1161/CIRCULATIONAHA.114.009703
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