Polyarteritis nodosa with bilateral renal artery aneurysms and perirenal haematomas: angiographic and nephrotomographic features

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Abstract
Over 1,000 cases of polyarteritis nodosa have been reported in the medical literature. It is, therefore, rather surprising that so little documentation of the radiographic features of this disease is available. Recently, a few reports of cases with arteriographically demonstrable intrarenal aneurysms have appeared (Bron, Strott and Shapiro, 1965; Fleming and Stern, 1965; Horner, Hunt, Kincaid and De-Weed, 1966; Chudacek, 1966; 1967; Lang, 1967), and it appears that the demonstration of bilateral multiple intrarenal aneurysms, particularly involving the arcuate and interlobar vessels, is diagnostic of polyarteritis (Bron et al., 1965). The nephrotomographic appearance of polyarteritis in the kidneys has not previously been mentioned in the literature. In this communication we record the sixth case of polyarteritis nodosa with angiographic demonstration of renal artery aneurysms and also show an interesting sequence of changing nephrotomograms which probably is specifically diagnostic of perirenal haematomas in this disease. This 37-year-old white male first presented with polyarthritis in 1959, and a diagnosis of rheumatoid arthritis was made by his local physician. In 1967, he was found to have hypertension. L.E. preparations were reported as positive at that time and a diagnosis of systemic lupus erythematosus was made. On his first admission to the National Institutes of Health in October, 1967 he had a blood pressure of 160/130, joint deformities suggestive of rheumatoid arthritis, iatrogenic Cushing's disease, microscopic haematuria, BFT positive in a dilution of 1 to 2,048 and negative L.E. preps.

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