Sonographic Examination in the Evaluation of Temporal Arteritis: A Key Diagnostic Component May Help Patients Avoid Surgery

Temporal arteritis (TA), otherwise known as giant cell arteritis (GCA), is a type of large vessel vasculitis. Also classified as a systemic rheumatic disease, TA targets muscular arteries from the cranial branch of the aorta, often causing characteristic symptoms, including a risk of vision loss. Duplex ultrasound has proven to be reliable in the diagnosis of GCA with imaging demonstrating a thickened, dark arterial wall surrounding the vessel lumen most notably on color Doppler, also referred to as the ‘halo’ sign, thought to represent the inflammation associated with the disease process. Here we review 2 female patients with suspected TA, with an emphasis on the importance of specific duplex imaging findings for preliminary patient diagnosis. The first case involved an 83-year-old woman presenting with headache, jaw pain, bilateral superficial temporal artery tenderness, and elevated erythrocyte sedimentation rate (ESR). Temporal artery duplex revealed periarterial inflammation of the bilateral temporal arteries and mild halo signs bilaterally. Bilateral temporal artery biopsy resulted in positive pathologic examination for TA. Following steroid therapy, the patient’s symptoms improved significantly. The second case involved a 90-year-old woman who presented with chronic right-sided temporal headaches and elevated ESR. Duplex imaging of the bilateral temporal arteries revealed halo signs within the bilateral frontal, parietal, and temporal arteries. The patient was treated with steroid therapy and showed notable symptomatic improvement. Duplex evaluation in the workup of GCA should be considered essential and may help patients avoid surgical biopsy.