A 67-year-old Japanese woman with rheumatoid arthritis of 30 years duration presented with digital gangrene (Fig. 1) and diarrhea. The conventional angiography showed a left medial plantar artery aneurysm (an arrow, Fig. 2A), a left renal artery aneurysm (an arrow, Fig. 2B), and an ileocolic artery aneurysm (an arrow, Fig. 2C). Based on her symptoms and the results of the conventional angiography, she was diagnosed with polyarteritis nodosa. Gangrene of the lower limb in a patient with rheumatoid arthritis might suggest rheumatoid vasculitis or arterial occlusive disease, but both were unlikely due to the negative rheumatoid factor and the absence of atherosclerosis on computed tomogra-phy. Polyarteritis nodosa is typically a medium-sized vasculitis with visceral artery aneurysms, but microaneurysms may not be detectable on computed tomography or magnetic resonance imaging. In such cases, it may be advisable to perform conventional angiography to diagnose before organ damage occurs.

We report a case of cerebral fat embolism (CFE) that could be identified only by susceptibility weighted imaging (SWI). Collection and analysis of previous case reports of CFE revealed utilization of SWI in less than one third of suspected cases, despite its known diagnostic ability for CFE.