Differential Diagnosis for Irregular Beaded Appearance on CT Angiogram
Single Most Likely Diagnosis
- Giant Cell Arteritis (GCA): This condition is a leading cause of monocular vision loss in older adults, especially when associated with hypertension. The irregular beaded appearance on CT angiogram is consistent with vasculitis affecting the ophthalmic arteries, a hallmark of GCA.
Other Likely Diagnoses
- Atherosclerotic Disease: Given the patient's age and history of hypertension, atherosclerotic changes in the arteries could lead to an irregular appearance on CT angiogram. This could potentially cause vision loss if the ophthalmic or posterior ciliary arteries are affected.
- Vasculitis (other forms): Other types of vasculitis, such as polyarteritis nodosa or granulomatosis with polyangiitis, could also present with similar findings, although they are less common than GCA in this demographic.
Do Not Miss Diagnoses
- Ophthalmic Artery Aneurysm or Pseudoaneurysm: Although less likely, an aneurysm or pseudoaneurysm of the ophthalmic artery could present with an irregular beaded appearance on imaging. Missing this diagnosis could lead to severe consequences, including vision loss or even rupture.
- Arteriovenous Malformation (AVM): An AVM involving the ophthalmic artery could also cause monocular vision loss and have an irregular appearance on CT angiogram. The risk of hemorrhage makes this a critical diagnosis not to miss.
Rare Diagnoses
- Moyamoya Disease: This rare condition involves stenosis or occlusion of the internal carotid artery and its branches, leading to the formation of a network of small, fragile vessels. It could potentially cause vision loss and have an irregular appearance on imaging, but it is much less common in this age group and demographic.
- Primary Angiitis of the Central Nervous System (PACNS): This is a rare form of vasculitis that affects the blood vessels of the brain and spinal cord. It could potentially involve the ophthalmic arteries and cause vision loss, but it is a rare condition and would be less likely than other diagnoses listed here.