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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

Polyarteritis Nodosa

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