Ruptured hepatic aneurysm as first presenting symptom of polyarteritis nodosa

Abstract

Polyarteritis nodosa (PAN) is an inflammatory vasculitis that creates regions of stenosis and aneurysm formation. The authors describe a 66-year-old female with hepatic artery rupture as the first presentation of undiagnosed PAN, presenting with abdominal pain followed by hemorrhagic shock. This aneurysm was suture ligated with a successful outcome. A mesenteric arteriogram demonstrated lesions consistent with PAN including aneurysms of the left gastric branches, right and left hepatic arteries, and beaded appearance of the iliac artery. However, she developed massive pulmonary embolism from which she did not recover after discharge. Postmortem examination confirmed left hepatic artery aneurysm rupture and changes consistent with PAN on gross anatomical examination and histology. This report provides a unique overview of the disease process through imaging, gross anatomic specimen and pathology. Life-threatening hepatic artery aneurysm rupture is an uncommon presentation of PAN which may benefit readers in creating a more robust differential diagnosis.

Mycotic Aneurysm of the Hepatic Artery: A Case Report and its Management

“…A vasculitis such as polyarteritis nodosa has been reported to result in the formation of aneurysms. [5] Pseudoaneurysm formation can occur after trauma to the hepatic artery; furthermore, there have even been cases of pseudoaneurysm formation trauma from a percutaneous biopsy. [6] Diagnostic testing Before definitive treatment, most patients with known or suspected mycotic aneurysms undergo essential diagnostic testing, including complete blood count, comprehensive metabolic panel, gram stain, blood cultures, and sensitivities, as well as contrast-enhanced CT or magnetic resonance imaging.…”

“…A vasculitis such as polyarteritis nodosa has been reported to result in the formation of aneurysms. [ 5 ] Pseudoaneurysm formation can occur after trauma to the hepatic artery; furthermore, there have even been cases of pseudoaneurysm formation trauma from a percutaneous biopsy. [ 6 ]…”

A large superior mesenteric artery aneurysm and ileal obstruction: a rare presentation of polyarteritis nodosa in an infant

“…Although aneurysms are common findings associated with PAN, large aneurysms are rarely reported in the SMA [1]. Previous case studies have reported rupturing of visceral arteries with aneurysm caused by PAN [6]. Litt et al.…”

Polyarteritis nodosa: An unusual cause of life-threatening intra-abdominal bleeding

“…An initial presentation with spontaneous intra-abdominal bleeding is unusual, but has the risk of a lethal outcome. [11,12] This makes adequate diagnosis, by means of visceral angiography, and subsequent (interventional) treatment necessary. [13] 4.…”