Classic imaging for polyangitis nodosa

Excerpt

An 18-year-old female patient presented to our hospital suffering from headache and nausea for 1 month, and fever and malaise for 10 days. On admission, physical examination revealed elevated blood pressure (210/160 mmHg), fever (peak temperature 40.5 °C) and a grade 3/6 systolic ejection murmur but without vascular murmur in the renal region. Laboratory tests showed an elevated erythrocyte sedimentation rate of 78.0 mm/h and C-reactive protein of 17.1 mg/dL. Complete blood count showed WBC 3,130/mm³, hemoglobin 11.6 g/dL, and platelet 195,000/mm³. No microscopic hematuria was observed. Urinary protein was 0.56 g/24 h. Blood urea nitrogen was 14 mg/dL, serum creatinine was 0.7 mg/dL, and serum albumin was 4.08 g/dL. Hepatitis B surface antigen was negative. Serum electrolyte test showed potassium 2.63 mmol/L, sodium 128.2 mmol/L, and chlorine 88.6 mmol/L. Anticardiolipin antibodies, antineutrophil antibodies, antinuclear antibody, and extractable nuclear antigen were all negative. A computed tomograpy (CT) scan of the abdomen with contrast showed wedge-shaped areas of low density in both kidneys suggesting renal infarction (Fig. 1). Therefore, three-dimensional (3D) post-processing techniques were employed to produce images simulating conventional angiograms which showed multiple microaneurysms within the bilateral renal parenchyma as well as bilateral perirenal hematomas (Fig. 2). Polyangitis nodosa (PAN) was highly suspected. Digital subtraction angiography (DSA) was performed demonstrating typical multiple aneurysms in the small and medium arteries (Fig. 3). Based on the clinical picture and angiographic evidence, PAN was diagnosed.

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