Return to case
Polyarteritis Nodosa
Submitted by Alexander Trebelev, MD*
- Systemic necrotizing inflammation of medium-sized
and small muscular arteries
- More common in adult males
- Spares the arterioles, capillaries, venules and
glomeruli
- Associated with hepatitis B antigenemia
- Signs and symptoms
- Abdominal pain
- Systemic hypertension
- Anorexia and weight loss
- Abdominal distention
- Hematemesis, melena
- Jaundice
- Painless hematuria
- Peripheral neuropathy
- Tender subcutaneous nodules
- Gangrene of fingers and toes
- Kidney (most frequently affected): 85%
Injection of right renal artery demonstrates multiple intrarenal
aneurysms (with acknowledgement to Juan Oleaga, MD, FACR and Paul Brady,
MD)
- Multiple intrarenal aneurysms
- Aneurysms may thrombose and disappear
- Multiple small cortical infarcts
- Angiographic findings
- 1-5 mm saccular aneurysms of small and
medium-sized arteries in 60-75% of cases
- Secondary to necrosis of internal elastic
lamina
- Luminal irregularities and stenoses
- Arterial occlusions and small tissue infarcts
- Lung (70% of cases)
- Findings are variable and rarely characteristic
enough to allow diagnosis
- Most characteristic pattern is fleeting, patchy
consolidation identical to Loeffler's
- Pericardial effusion
- Pleural effusion
- Discoid atelectasis
- Nodules which may cavitate
- Patchy consolidation
- Liver: affected 66% of cases
Selective injection of the hepatic artery demonstrates multiple
intrahepatic aneurysms. There are no aneurysms in the periphery of
the liver because of a large subcapsular hematoma as a consequence of
the vasculitis (with acknowledgement to Juan Oleaga, MD, FACR and Paul
Brady, MD)
- Treatment
* With grateful acknowledgement to Juan Oleaga, MD, FACR and Paul
Brady, MD
- Bockus, Henry L. Gastroenterology, 3rd
ed., Vol. 4 Pages 538-541. W. B. Saunders Company, Philadelphia,
London, Toronto, 1976.
- Dahnert, Wolfgang Radiology Review Manual, 4th
ed. Page 533, Lippincott, Williams and Wilkins, Philadelphia,
Baltimore, etc., 2000.
|
