Polyarteritis Nodosa
Periarteritis 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%
  • Multiple intrarenal aneurysms

Multiple aneurysms of renal vessels in Polyarteritis

• Aneurysms may thrombose and disappear
  • Appear in new locations
• 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
   
• Treatment
  
  
  • Corticosteroids
    • 50% 5 year survival

1. Bockus, Henry L. Gastroenterology, 3^rd ed., Vol. 4 Pages 538-541. W. B. Saunders Company, Philadelphia, London, Toronto, 1976.
2. Dahnert, Wolfgang Radiology Review Manual, 4^th ed. Page 533, Lippincott, Williams and Wilkins, Philadelphia, Baltimore, etc., 2000.