Presentation
Increasing abdominal pain.
Patient Data
Right sided common femoral artery puncture and 5 French sheath were introduced. Non selective angiography was followed by selective angiogram of the left and right renal arteries, common hepatic artery and SMA using a 5 French C2 catheter.
Both kidneys demonstrate beading and numerous microaneurysms affecting the segmental, interlobar, and arcuate vessels.
Similar changes are seen affecting the intrahepatic vessels with a few small microaneurysms noted.
The proximal branches of the SMA appear normal; however there are no normal straight arteries from the jejunal arteries and lack of normal anastomotic arcades and loops. This is associated with multiple microaneurysms. The colic branches have more normal appearances though there are also scattered microaneurysms present.
Impression
Features are consistent with polyarteritis nodosa (PAN).
Case Discussion
Despite very suggestive radiological features, muscle and renal biopsies were negative. The patient was treated presumptively and has had a number of recurrent episodes. Long term follow-up unknown.
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