Churg-Strauss syndrome diagnostic study of choice: Difference between revisions

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__NOTOC__
__NOTOC__
{{Churg-Strauss syndrome}}
{{Churg-Strauss syndrome}}
{{CMG}}; {{AE}}
{{CMG}}; {{AE}}{{CK}}
== Overview ==
== Overview ==
There are no specific diagnostic studies to confirm the diagnosis of [[eosinophilic granulomatosis with polyangiitis]], [[High Resolution CT|High resolution CT scan]] of lung and [[biopsy]] from various organs may be helpful in confirming the disease.


== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==
*High resolution CT scan:<ref name="pmid20623310">{{cite journal |vauthors=Szczeklik W, Sokołowska B, Mastalerz L, Grzanka P, Górka J, Pacułt K, Miszalski-Jamka T, Soja J, Musiał J |title=Pulmonary findings in Churg-Strauss syndrome in chest X-rays and high resolution computed tomography at the time of initial diagnosis |journal=Clin. Rheumatol. |volume=29 |issue=10 |pages=1127–34 |date=October 2010 |pmid=20623310 |doi=10.1007/s10067-010-1530-3 |url=}}</ref><ref name="pmid15818205">{{cite journal |vauthors=Silva CI, Müller NL, Fujimoto K, Johkoh T, Ajzen SA, Churg A |title=Churg-Strauss syndrome: high resolution CT and pathologic findings |journal=J Thorac Imaging |volume=20 |issue=2 |pages=74–80 |date=May 2005 |pmid=15818205 |doi= |url=}}</ref><ref name="pmid21496416">{{cite journal |vauthors=Feng RE, Xu WB, Shi JH, Mahmoudi A, Mu WB, Zheng WJ, Zhu YJ, Liu HR |title=Pathological and high resolution CT findings in Churg-Strauss syndrome |journal=Chin. Med. Sci. J. |volume=26 |issue=1 |pages=1–8 |date=March 2011 |pmid=21496416 |doi= |url=}}</ref>
**[[High-resolution CT|High-resolution computerized tomography]] ([[High Resolution CT|HRCT]]) scan of patients with [[eosinophilic granulomatosis with polyangiitis]] will show the following findings:
*** Airspace consolidations mostly bilateral and lobular distribution
*** Ground-glass opacities, can be seen in a patchy or subpleural distribution, with inclination most commonly occurring in the lower zone portion of the [[lung]]
*** Centrilobular nodules
*** Bronchial wall thickening and/or dilatation
*** [[Pleural effusion|Pleural effusions]]
*** Hilar or [[mediastinal lymph node]] enlargement
*** Interlobular septal thickening


=== Study of choice ===
*Biopsy
* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
**Because of the multiple organ involvements, the biopsy should be obtained from any of the following organ sites:
* The following result of [gold standard test] is confirmatory of [disease name]:
***[[Lung]]:<ref name="pmid7952571">{{cite journal| author=Allen JN, Davis WB| title=Eosinophilic lung diseases. | journal=Am J Respir Crit Care Med | year= 1994 | volume= 150 | issue= 5 Pt 1 | pages= 1423-38 | pmid=7952571 | doi=10.1164/ajrccm.150.5.7952571 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7952571  }} </ref>
** Result 1
****The gold standard in establishing a diagnosis for eosinophilic granulomatosis with polyangiitis is a lung biopsy. surgical or transbronchial biopsy can be performed.
** Result 2
***[[Skin]]
* The [name of the investigation] should be performed when:
***[[Nerve]]
** The patient presented with symptoms/signs 1. 2, 3.
***[[Kidney]]
** A positive [test] is detected in the patient.
***[[Muscle]]
* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
**[[Biopsy]] findings may include infiltration by [[Eosinophil granulocyte|eosinophils]], vasculitis of small and medium-sized vessels and granuloma formation.
* The diagnostic study of choice for [disease name] is [name of the investigation].
* There is no single diagnostic study of choice for the diagnosis of [disease name].
* There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
* [Disease name] is mainly diagnosed based on clinical presentation.
* Investigations:
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.


==== The comparison of various diagnostic studies for [disease name] ====
=== Diagnostic Criteria ===
{|
According to the '''American College of Rheumatology classification criteria''' <ref name="pmid2202307">{{cite journal| author=Masi AT, Hunder GG, Lie JT, Michel BA, Bloch DA, Arend WP et al.| title=The American College of Rheumatology 1990 criteria for the classification of Churg-Strauss syndrome (allergic granulomatosis and angiitis). | journal=Arthritis Rheum | year= 1990 | volume= 33 | issue= 8 | pages= 1094-100 | pmid=2202307 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2202307  }}</ref>
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
{| class="wikitable"
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Test
|[[Asthma]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
 
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
[[Eosinophilia]]
|-
 
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
[[Polyneuropathy]] or [[Mononeuropathy]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
|}
<small> ✔= The best test based on the feature </small>


===== Diagnostic results =====
Non fixed pulmonary infiltrates
The following result of [investigation name] is confirmatory of [disease name]:
* Result 1
* Result 2


===== Sequence of Diagnostic Studies =====
[[Paranasal sinus]] that is abnormal
The [name of investigation] should be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.


=== Diagnostic Criteria ===
[[Eosinophil granulocyte|Eosinophils]] that are extravascular
* Here you should describe the details of the diagnostic criteria.
|
*Always mention the name of the criteria/definition you are about to list (e.g. modified Duke criteria for the diagnosis of endocarditis / 3rd universal definition of MI) and cite the primary source of where this criteria/definition is found.
Patients must express 4 out the 6 criteria to be diagnosed with [[eosinophilic granulomatosis with polyangiitis]].
*Although not necessary, it is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.
*Be very clear as to the number of criteria (or threshold) that needs to be met out of the total number of criteria.
*Distinguish criteria based on their nature (e.g. clinical criteria / pathological criteria/ imaging criteria) before discussing them in details.
*To view an example (endocarditis diagnostic criteria), click [[Endocarditis diagnosis|here]]
*If relevant, add additional information that might help the reader distinguish various criteria or the evolution of criteria (e.g. original criteria vs. modified criteria).
*You may also add information about the sensitivity and specificity of the criteria, the pre-test probability, and other figures that may help the reader understand how valuable the criteria are clinically.
* [Disease name] is mainly diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
* There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].


* The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
|}
* The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
According to '''Lanham diagnostic criteria''' <ref name="pmid6366453">{{cite journal| author=Lanham JG, Elkon KB, Pusey CD, Hughes GR| title=Systemic vasculitis with asthma and eosinophilia: a clinical approach to the Churg-Strauss syndrome. | journal=Medicine (Baltimore) | year= 1984 | volume= 63 | issue= 2 | pages= 65-81 | pmid=6366453 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6366453  }}</ref>
{| class="wikitable"
|[[Asthma]]


* [Disease name] may be diagnosed at any time if one or more of the following criteria are met:
[[Eosinophilia]] peak of >1.5x10<sup>9</sup> cell/L or >10% of the total [[White blood cells|WBC]]
** Criteria 1
** Criteria 2
** Criteria 3


IF there are clear, established diagnostic criteria:
[[Vasculitis|Systemic vasculitis]], two or greater extra  pulmonary sites
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
|
*The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
All 3 criteria’s need to be present
*The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
IF there are no established diagnostic criteria: 
*There are no established criteria for the diagnosis of [disease name].


|}


==References==
==References==

Latest revision as of 20:46, 12 April 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chandrakala Yannam, MD [2]

Overview

There are no specific diagnostic studies to confirm the diagnosis of eosinophilic granulomatosis with polyangiitis, High resolution CT scan of lung and biopsy from various organs may be helpful in confirming the disease.

Diagnostic Study of Choice

  • Biopsy
    • Because of the multiple organ involvements, the biopsy should be obtained from any of the following organ sites:
      • Lung:[4]
        • The gold standard in establishing a diagnosis for eosinophilic granulomatosis with polyangiitis is a lung biopsy. surgical or transbronchial biopsy can be performed.
      • Skin
      • Nerve
      • Kidney
      • Muscle
    • Biopsy findings may include infiltration by eosinophils, vasculitis of small and medium-sized vessels and granuloma formation.

Diagnostic Criteria

According to the American College of Rheumatology classification criteria [5]

Asthma

Eosinophilia

Polyneuropathy or Mononeuropathy

Non fixed pulmonary infiltrates

Paranasal sinus that is abnormal

Eosinophils that are extravascular

Patients must express 4 out the 6 criteria to be diagnosed with eosinophilic granulomatosis with polyangiitis.

According to Lanham diagnostic criteria [6]

Asthma

Eosinophilia peak of >1.5x109 cell/L or >10% of the total WBC

Systemic vasculitis, two or greater extra pulmonary sites

All 3 criteria’s need to be present

References

  1. ↑ Szczeklik W, Sokołowska B, Mastalerz L, Grzanka P, Górka J, Pacułt K, Miszalski-Jamka T, Soja J, Musiał J (October 2010). "Pulmonary findings in Churg-Strauss syndrome in chest X-rays and high resolution computed tomography at the time of initial diagnosis". Clin. Rheumatol. 29 (10): 1127–34. doi:10.1007/s10067-010-1530-3. PMID 20623310.
  2. ↑ Silva CI, Müller NL, Fujimoto K, Johkoh T, Ajzen SA, Churg A (May 2005). "Churg-Strauss syndrome: high resolution CT and pathologic findings". J Thorac Imaging. 20 (2): 74–80. PMID 15818205.
  3. ↑ Feng RE, Xu WB, Shi JH, Mahmoudi A, Mu WB, Zheng WJ, Zhu YJ, Liu HR (March 2011). "Pathological and high resolution CT findings in Churg-Strauss syndrome". Chin. Med. Sci. J. 26 (1): 1–8. PMID 21496416.
  4. ↑ Allen JN, Davis WB (1994). "Eosinophilic lung diseases". Am J Respir Crit Care Med. 150 (5 Pt 1): 1423–38. doi:10.1164/ajrccm.150.5.7952571. PMID 7952571.
  5. ↑ Masi AT, Hunder GG, Lie JT, Michel BA, Bloch DA, Arend WP; et al. (1990). "The American College of Rheumatology 1990 criteria for the classification of Churg-Strauss syndrome (allergic granulomatosis and angiitis)". Arthritis Rheum. 33 (8): 1094–100. PMID 2202307.
  6. ↑ Lanham JG, Elkon KB, Pusey CD, Hughes GR (1984). "Systemic vasculitis with asthma and eosinophilia: a clinical approach to the Churg-Strauss syndrome". Medicine (Baltimore). 63 (2): 65–81. PMID 6366453.

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