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Case Reports
. 2015 Mar;24(1):63-6.
doi: 10.1055/s-0033-1354306.

Polyarteritis nodosa-induced pancreaticoduodenal artery aneurysmal rupture

Steven Levin  1 , John Graber  2 , Eduardo Ehrenwald  2 , Nedaa Skeik  2
Affiliations
Case Reports

Polyarteritis nodosa-induced pancreaticoduodenal artery aneurysmal rupture

Steven Levin et al. Int J Angiol. 2015 Mar.

Abstract

Polyarteritis nodosa (PAN) is a systemic, necrotizing vasculitis of small- and medium-sized arteries typically with multiorgan involvement. Most cases of PAN are idiopathic, although hepatitis B or C virus infections and hairy cell leukemia are important in the pathogenesis of some cases. PAN is characterized as segmental transmural inflammation of muscular arteries. Diagnosis is based on clinical suspicion, a negative immunofluorescence test for antineutrophil cytoplasmic antibodies, and whenever possible, biopsy conformation. Angiographic images may reveal microaneurysms affecting the renal, hepatic, or mesenteric vasculature. Aneurysmal formation and rupture are important complications that can be fatal. Treatment may warrant immunosuppression with steroids and cyclophosphamide. If left untreated, PAN can be fatal. To our knowledge, we report the second documented case of PAN-induced ruptured inferior pancreaticoduodenal artery aneurysm.

Keywords: C-reactive protein; aneurysm; arteritis; coil embolization; mesenteric artery; vasculitis; vessel repair.

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Figures

Fig. 1
Fig. 1
Axial computed tomography image of the abdomen showing retroperitoneal hematoma measuring 3.1 cm near the abdominal aorta but not directly communicating with it.
Fig. 2
Fig. 2
Coronal abdominal computed tomography scan image demonstrating the inferior pancreaticoduodenal artery in direct communication with the hematoma.
Fig. 3
Fig. 3
Pathological specimen of pancreaticoduodenal artery showing a muscular artery with medial fibrinoid degeneration (arrow) and adventitial leukocytic infiltrate, consistent with polyarteritis nodosa.
Fig. 4
Fig. 4
Additional area of the pancreaticoduodenal artery with prominent fibrinoid degeneration, medial disruption, and aneurysm formation.
See this image and copyright information in PMC

References

    1. Jennette J C, Falk R J, Bacon P A. et al.2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum. 2013;65(1):1–11. - PubMed
    1. Parent B A, Cho S W, Buck D G, Nalesnik M A, Gamblin T C. Spontaneous rupture of hepatic artery aneurysm associated with polyarteritis nodosa. Am Surg. 2010;76(12):1416–1419. - PubMed
    1. Herskowitz M M, Flyer M A, Sclafani S J. Percutaneous transhepatic coil embolization of a ruptured intrahepatic aneurysm in polyarteritis nodosa. Cardiovasc Intervent Radiol. 1993;16(4):254–256. - PubMed
    1. Nakashima M, Suzuki K, Okada M, Takada K, Kobayashi H, Hama Y. Successful coil embolization of a ruptured hepatic aneurysm in a patient with polyarteritis nodosa accompanied by angioimmunoblastic T cell lymphoma. Clin Rheumatol. 2007;26(8):1362–1364. - PubMed
    1. Suzuki K, Tachi Y, Ito S. et al.Endovascular management of ruptured pancreaticoduodenal artery aneurysms associated with celiac axis stenosis. Cardiovasc Intervent Radiol. 2008;31(6):1082–1087. - PubMed

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