J Korean Soc Emerg Med.  2007 Aug;18(4):351-354.

A Case of Rupture of a Renal Artery Aneurysm in Polyarteritis Nodosa which is predicted early in Emergency Department

• Kim SP
• Sun KH
• Cho SH
• Cho NS
• Byun JN

Abstract

Polyarteritis nodosa (PAN) is a necrotizing angitis that predominantly affects small-and medium-sized arteries in which microaneurysm or occlusion of the visceral arteries can be seen by arteriography. Patients with PAN may have non-specific symptoms at the beginning of their illness, but progression can be sudden and result in severe, even life threatening, complications. These include central nervous system hemorrhages, gastrointestinal hemorrhages or perforation, acute appendicitis, liver infarcts, acute renal failure, renal perirenal hematomas, and cardiac failure. A diagnosis of PAN should be considered when multiple small-sized aneurysms are detected by angiography, even if a biopsy is negative. Involvement of gastrointestinal and renal arteries is frequent in polyarteritis nodosa. The most common complications of gastrointestinal involvement are mucosal ulceration, bowel infarction, perforation, cholecystitis and hepatitis. Another rare but potentially life-threatening complication is perirenal hematoma caused by spontaneous rupture of renal aneurysm. Because of this possibility, rapid evaluation of these patients is necessary to make early diagnosis and treatment possible. We describe an extremely rare case of polyarteritis nodosa with development of spontaneous perirenal hematoma due to rupture of renal aneurysm, which was evaluated with immediate angiography and treated by coil embolization.

Keyword

Polyarteritis nodosa; Ruptured aneurysm; Hematoma.

MeSH Terms

Acute Kidney Injury
Aneurysm*
Aneurysm, Ruptured
Angiography
Appendicitis
Arteries
Biopsy
Central Nervous System
Cholecystitis
Diagnosis
Early Diagnosis
Embolization, Therapeutic
Emergencies*
Emergency Service, Hospital*
Gastrointestinal Hemorrhage
Heart Failure
Hematoma
Hemorrhage
Hepatitis
Humans
Infarction
Liver
Polyarteritis Nodosa*
Renal Artery*
Rupture*
Rupture, Spontaneous
Ulcer