Spontaneous Perirenal Hematoma: A Complication of Polyarteritis Nodosa

Abstract

Polyarteritis nodosa is a rare cause of perirenal hematoma owing to rupture of 1 of the aneurysms. Eleven cases have been reported previously in the English literature, including 5 with a preoperative angiographic diagnosis. Our case, which was diagnosed angiographically before a successful conservative operation, is the first report of a patient who survived 3 years. The pathology is discussed.

Spontaneous Kidney Rupture in Polyarteritis nodosa Report of Four Cases

“…Nearly 20 cases of spontaneous rupture of the kidney are documented in the English literature. While some patients were suc cessfully managed conservatively [5,7], others needed bilateral nephrectomy and renal transplantation [9]. Three of our patients were operated in the state of hypovolemic shock and all 4 kidneys were found ruptured during exploration.…”

“…In 72-79% of the autopsy studies of patients with PAN, the kidneys are affected and changes of multiple infarctions, arterial aneurisms and glomerulonephritis are noted [2], Spontaneous kidney rupture with resultant perirenal hematoma is rare, but may be the initial presentation of this systemic disorder [3]. In a series of 130 cases of PAN seen at the Mayo Clinic, there were no spontaneous kidney ruptures or hematoma [4], Nearly 20 cases are documented in the English literature [3,[5][6][7][8][9]. We herein present 4 patients with spontaneous kidney rupture, 1 of whom had bilateral disease, and discuss the treatment.…”

Polyarteritis nodosa Presenting as Perirenal Hemorrhage

“…Though SPH as a complication of PAN was first described in 1908 [3], it is a distinctly rare complication of it [2,[4][5][6][7][8][9], The renal hemorrhage is generally due to aneurysmal rupture but can be rarely due to renal arterial dissection or rupture [10,11]. The usual presenting fea ture is the sudden development of severe flank pain or abdominal pain with development of abdominal mass, and in more severe cases vascular collapse can occur.…”

Spontaneous Perirenal Haematoma Secondary to Polyarteritis Nodosa

“…Including our patients, there have been 15 documented cases of SPH associated with PAN in the English literature (Fort, 1948;Ostrum and Soder, 1960;McClure and Westcott, 1969;McDougal e? al., 1975;Litvak et al, 1976;Smailowitz et al, 1979). This unusual and serious entity generally results from rupture of an intraparenchymal aneurysm.…”

“…1). It is also useful in planning an operative approach (Smailowitz et al, 1979;Swift et al, 1980). A ruptured aneurysm resulting in SPH usually necessitates an emergency operation.…”