High-Resolution Color-Coded Sonography in Angiolymphoid Hyperplasia With Eosinophilia Presenting as Temporal Arteritis

Abstract

A 37-year-old white man presented with extensive and mildly painful swelling of both superficial temporal arteries (STAs) (Figure, upper left). The condition was progressive for 4 weeks, and the patient had mild night sweats. He noticed a circadian rhythm with less prominent STA swelling in the morning. No other deficits, including claudicatio masticatoria, visual symptoms, or (any) neurological symptoms, were reported. High-resolution color-coded sonography (Siemens Sequoia, 15L transducer, Mountain View, Calif) revealed highly enlarged STA bilaterally, with a diameter of up to 9 mm and sinusoidal intraluminal vessels with arteriovenous blood flow velocities (Figure, middle, and Movie in the online-only Data Supplement) and some areas with a hypoechoic rim (“halo” sign). Furthermore, swelling of the occipital arteries and enlarged cervical lymph nodes were found. Clinical chemistry revealed eosinophilia of 17% with an almost unremarkable blood sedimentation rate (20 mm/2 hour), whereas other lab parameters, including leukocyte …