Lung involvement in polyarteritis nodosa Poster No.:
A. Ivkovic, T. Milosavljevic, S. Ivkovic; NIS/RS
Chronic obstructive airways disease, Computer ApplicationsVirtual imaging, Computer Applications-Detection, diagnosis, Computer Applications-3D, MR-Angiography, CT-High Resolution, CT-Angiography, Pulmonary vessels, Lung, Computer applications
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Learning objectives Polyarteritis nodosa (PAN) is a systemic inflammatory necrotising vasculitis that involves small to medium sized muscular arteries (larger than arterioles).
Background Polyarteritis nodosa (PAN) is characterized by necrotizing arteritis of medium-sized and small arteries in various organs. Pulmonary artery involvement in PAN has been considered rare. Previously, it also has been thought that patients with PAN do not have interstitial pneumonitis and fibrosis. A detailed pathologic analysis of pulmonary diseases associated with PAN was made in 10 autopsy cases of PAN. Arteritis affecting bronchial arteries was present in seven patients (70%). The data obtained suggest that arteritis in the lung in patients with PAN is more common than has been recognized previously. Diffuse alveolar damage (DAD) involving all lobes bilaterally was present in five patients; it was acute in two patients and organizing in three. In the patients with organizing DAD the degree of fibrosis in the interstitium differed among the lobes, and the fibrosis was more severe in the lower lobe than in the other lobes. Two patients presented with interstitial fibrosis with honeycomb lung of the posterior and lateral basal segments of the lower lobes of both lungs; in one of these patients interstitial fibrosis was present in an area of organizing DAD. Five patients died of respiratory failure resulting from DAD. In conclusion, it is important to consider DAD and interstitial fibrosis as complications of PAN.
Imaging findings OR Procedure details Patients can present with systemic and focal symptoms. Nonspecific systemic signs and symptoms are almost always present and include fever, malaise and weight loss. Localized symptoms relate to ischemia and infarction of affected tissues and organs. The most commonly involved vessels, are the renal arteries, with visceral involvement also considered relatively common. The pulmonary circulation is typically spared, although bronchial arteries may occasionally be involved. Frequent sites of involvement are renal: 159 (87.85%): tends to be the prominent site and major cause of death, cardiac: 126 (69.61%), gastrointestinal tract: 97 (53.59%), hepatic: 89 (49.17%), spleen: 74 (40.88%), pancreas: 46 (25.41%), CNS complications: 38 (20.99%). Arteritis affecting bronchial arteries was present in 129 patients (71.27%). Diffuse alveolar damage (DAD) involving all lobes bilaterally was present in 98 patients (54.14%); it was acute in 64 patients (65.31%) and organizing in 34 (34.69%). In the patients with organizing DAD the degree of fibrosis in the interstitium differed among the lobes, and the fibrosis was more severe Page 2 of 7
in the lower lobe than in the other lobes. 37 patients presented with interstitial fibrosis with honeycomb lung of the posterior and lateral basal segments of the lower lobes of both lungs; in one of these patients interstitial fibrosis was present in an area of organizing DAD. In conclusion, it is important to consider DAD and interstitial fibrosis as complications of PAN. Images for this section:
Fig. 1: MDCT 1 lung
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Fig. 2: MDCT 2 lung
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Fig. 3: MDCT lung
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Fig. 4: MDCT lung
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Conclusion PAN may result in death of patients. MDCT examinations have a great role in diagnostic and follow up of PAN. MRI with DWI is great tool for determining of small vessels and mediastinum.
References 1. Rhodes ES, Pekala JS, Gemery JM et-al. Case 129: Polyarteritis nodosa. Radiology. 2008;246 (1): 322-6. doi:10.1148/radiol.2461040002 - Pubmed citation 2. Stanson AW, Friese JL, Johnson CM et-al. Polyarteritis nodosa: spectrum of angiographic findings. Radiographics. 21 (1): 151-9. Radiographics (full text) - Pubmed citation 3. Ha HK, Lee SH, Rha SE et-al. Radiologic features of vasculitis involving the gastrointestinal tract. Radiographics. 20 (3): 779-94. Radiographics (full text) - Pubmed citation 4. Provenzale JM, Allen NB. Neuroradiologic findings in polyarteritis nodosa. AJNR Am J Neuroradiol. 17 (6): 1119-26. AJNR Am J Neuroradiol (abstract) - Pubmed citation 5. Jee KN, Ha HK, Lee IJ et-al. Radiologic findings of abdominal polyarteritis nodosa. AJR Am J Roentgenol. 2000;174 (6): 1675-9. AJR Am J Roentgenol (full text) - Pubmed citation
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