Radiologic Findings of Abdominal Polyarteritis Nodosa

Jee, Keum Nahn; Ha, Hyun Kwon; Lee, In Jae; Kim, Jeong Kon; Sung, Kyu‐Bo; Cho, Kyoung-Sik; Kim, Pyo Nyun; Lee, Moon-Gyu; Lim, Hyo Keun; Choi, C.Joon; Auh, Yong Ho

doi:10.2214/ajr.174.6.1741675

Cited by 52 publications

(18 citation statements)

References 11 publications

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“…Testicular involvement in systemic PAN is common, with a prevalence of up to 85%. [6] We identified an isolated study in the literature, evaluating the radiographic findings of abdominal PAN, where extrarenal PAN (urethral, bladder) was found in 2 of the 7 patients studied. [5] However, to our knowledge, PAN involving the urinary tract (especially the urethra and bladder neck) is not well described in the literature.…”

Section: Discussionmentioning

confidence: 99%

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Polyarteritis nodosa presenting as a bladder outlet obstruction

et al. 2016

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Polyarteritis nodosa (PAN) of the urinary tract is rare. An unusual case of systemic PAN involving the bladder neck is described. A 27-year-old man, with known diastolic hypertension diagnosed 2 years earlier, was admitted with chronic urinary obstruction complicated by hydronephrosis. He had symptoms of myalgia and weight loss, was afebrile but had an elevated erythrocyte sedimentation rate and acute-on-chronic renal impairment. All virological and serological tests including hepatitis B and anti-neutrophil cytoplasmic antibody were negative. A computed tomography scan of the brain revealed small-vessel disease. A bladder neck mass was visualised on cystoscopy. Histological examination of this demonstrated a medium-sized necrotising vasculitis with small-vessel fibrinoid necrosis suggestive of PAN. At least six of the American College of Rheumatology criteria for PAN were met. The patient was treated with pulses of intravenous cyclophosphamide and oral corticosteroids with a good clinical response. Polyarteritis nodosa (PAN) was first described by Kussmaul and Maier [1] in 1866. The annual incidence is <1/million/year, while an incidence of 77/million/year has been recorded in hepatitis B virus (HBV)-endemic areas, with a male/female ratio of 2 -3:1.[2] The Chapel Hill Consensus Conference in 1994 defined PAN as 'necrotizing inflammation of medium sized or small arteries without glomerulonephritis or vasculitis in arterioles, capillaries or venules' .[3] PAN can be primary or secondary to viral infection (e.g. HBV).[4] Antineutrophil cytoplasmic antibody (ANCA) testing is usually negative, which essentially differentiates it from microscopic polyangiitis.[4] The disease often presents with vague and nonspecific signs and symptoms such as myalgia, arthralgia, fever, headaches, neuropathy and features of chronic kidney disease, and can manifest with symptoms of transient ischaemic attacks.[3] If left untreated, PAN is usually fatal as a result of progressive renal failure or gastrointestinal complications. [3] The urological manifestations of PAN documented in the literature include ureteric stenosis and orchitis. [5,6] We present a case of systemic PAN involving the bladder in a man presenting with a bladder outlet obstruction due to a mass. Case reportA 27-year-old man was admitted to a urology ward with chronic urinary obstruction and hydronephrosis diagnosed on an ultrasound scan. This was accompanied by severe myalgia, loss of weight (approximately 10 kg over 6 months) and suprapubic pain. His past history included only hypertension, diagnosed in 2010, which was never investigated for a possible secondary cause.He was afebrile and a complete physical examination was un remarkable. Diastolic blood pressure readings were noted to be consistently elevated (>90 mmHg).Laboratory tests showed marked renal impairment (serum creatinine level 1 096 µmol/L), with a normocytic anaemia, an elevated erythrocyte sedimentation rate (105 mm/h) and an elevated C-reactive protein level of 65 mg/L. All virological and serologi...

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Section: Discussionmentioning

confidence: 99%

“…[3] The urological manifestations of PAN documented in the literature include ureteric stenosis and orchitis. [5,6] We present a case of systemic PAN involving the bladder in a man presenting with a bladder outlet obstruction due to a mass. …”

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confidence: 99%

Polyarteritis nodosa presenting as a bladder outlet obstruction

et al. 2016

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“…Doppler ultrasound can show aneurysms of PAN, but there is no information in the literature regarding its sensitivity and specificity in the diagnosis of PAN. Ultrasonography and CT can also detect perirenal hematomas and other features compatible with PAN, even if aneurysms are not demonstrable [2]. On the other hand, conventional angiography is mandatory if lesions cannot be demonstrated with these newer techniques.…”

Section: Discussionmentioning

confidence: 99%

Polyarteritis nodosa: successful diagnostic imaging utilizing pulsed and color Doppler ultrasonography and computed tomography angiography

et al. 2005

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The diagnosis of polyarteritis nodosa (PAN) is often delayed because patients present with diverse clinical symptoms, but with less disease-specific signs. However, early diagnosis and treatment of PAN is necessary to prevent serious organ damage. Herein, we present a boy in whom the diagnosis of classical PAN was established rapidly with ultrasound and computed tomography (CT) angiography. Moreover, complete disappearance of the aneurysms after one month of therapy was documented. This case is presented in order to underline the role of new imaging techniques in the diagnosis and follow-up of patients with PAN.

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“…Le scanner abdominal peut, toutefois, montrer des épaississements inflammatoires des parois des anses digestives, parfois évocateurs (mais non spécifiques) (Fig. 2), liés à l'ischémie des muqueuses et des sousmuqueuses, associés dans de rares cas à une pneumatose, voire à des images gazeuses dans le réseau veineux porte [49]. La mise en évidence sur le scanner d'anévrismes artériels rénaux, hépatiques, spléniques, coliques et/ou mésentériques (au cours de la périartérite noueuse) est très exceptionnelle.…”

Section: Explorations Digestives Complémentaires (Radiologiques Endounclassified

Manifestations digestives et ischémie mésentérique au cours des vascularites systémiques

Pagnoux

2010

Colon Rectum

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Les vascularites systémiques peuvent être primitives, classées selon le calibre des vaisseaux atteints, ou secondaires, conséquence d'une infection, d'une prise médi-camenteuse, d'un cancer ou d'une autre maladie systémique comme la polyarthrite rhumatoïde. Des manifestations digestives peuvent survenir, à des fréquences variables, au cours de ces vascularites et révèlent la maladie chez environ 15 % des patients. Les douleurs abdominales, les nausées, les vomissements ou les diarrhées sont fréquents, mais peu spécifiques. Une inflammation, un infiltrat purpurique et/ou nécrotique et des ulcérations (parfois d'allure granulomateuse) des muqueuses sont possibles. Les atteintes ischémi-ques, les infarctus et les perforations intestinales, surtout de l'intestin grêle, sont plus graves, de même que les atteintes pancréatiques et les hémorragies digestives (notamment par rupture de microanévrismes). La prise en charge combinée médicale, et chirurgicale si nécessaire, doit être précoce. La survie à dix ans des patients atteints de vascularite systé-mique nécrosante primitive est, aujourd'hui, de l'ordre de 80 %, en l'absence d'atteinte digestive ou si les manifestations digestives sont mineures. Le taux de survie à cinq ans Les cinq points utiles à la thérapeutique • La fréquence des manifestations digestives au cours des vascularites systémiques primitives est variable. Elle peut atteindre 50 % en cas d'artérite de Takayasu et 85 % en cas de purpura rhumatoïde. Elles sont plus rares mais possibles au cours des vascularites secondaires, notamment celles liées à la polyarthrite rhumatoïde ;• les manifestations digestives peuvent être isolées et révélatri-ces de la vascularite ;• les symptômes digestifs sont fréquents, mais peu spécifiques.Leur persistance après mise en route du traitement médical doit faire craindre une complication chirurgicale, qui peut être masquée par la prise des corticoïdes ;

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Radiologic Findings of Abdominal Polyarteritis Nodosa

Abstract: Vasculitis should be considered when multiple abdominal organs have abnormal radiologic findings; however, angiography is necessary to specifically diagnose polyarteritis nodosa.

Cited by 52 publications

References 11 publications

Polyarteritis nodosa presenting as a bladder outlet obstruction

Polyarteritis nodosa presenting as a bladder outlet obstruction

Polyarteritis nodosa: successful diagnostic imaging utilizing pulsed and color Doppler ultrasonography and computed tomography angiography

Manifestations digestives et ischémie mésentérique au cours des vascularites systémiques

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