EURORAD ESR

Case 14199

Polyarteritis Nodosa with Miocardial and Kidney Infarcts, Multiple Aneurysm and Hemoperitoneum

Author(s)
Palma Ceppi, Rodrigo; Astudillo Jara, Jaime; Cermenati Bahrs, Tomás; Palavecino Bustos, Tamara; Palavecino Rubilar, Patricio; Ramos Gómez, Cristóbal; Herquiñigo Reckmann, David

Hospital Clínico Universidad de Chile, Universidad de Chile; Santos Dumont 999, 8380456 Santiago; Email:palmarodrigo@gmail.com
 
Patient
female, 56 year(s)
 
 
  • Figure 1
    Acute myocardial infarction
     

    Vertical long axis, short axis and four chamber views show hypodense myocardium in the antero-lateral wall an papilary muscle.

     
    Area of Interest: Cardiovascular system; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Special Focus: Ischaemia / Infarction;

    Vertical long axis, short axis and four chamber views show hypodense myocardium in the antero-lateral wall an papilary muscle.

     
    Area of Interest: Cardiovascular system; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Special Focus: Ischaemia / Infarction;

    Vertical long axis, short axis and four chamber views show hypodense myocardium in the antero-lateral wall an papilary muscle.

     
    Area of Interest: Cardiovascular system; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Special Focus: Ischaemia / Infarction;

    Vertical long axis, short axis and four chamber views show hypodense myocardium in the antero-lateral wall an papilary muscle.

     
    Area of Interest: Cardiovascular system; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Special Focus: Ischaemia / Infarction;
     
     
  • Figure 2
    First marginal branch occluded of LCX

    Coronarography show the first marginal branch of the left circumflex artery (LCX) occluded.

     
    Area of Interest: Cardiovascular system; Imaging Technique: Fluoroscopy; Procedure: Angioscopy; Special Focus: Ischaemia / Infarction;
     
     
  • Figure 3
    Kidney infarction and haemoperitoneum
     

    Axial contrast-enhanced computed tomography showing a wedge-shaped and sharply demarcated hypodense area on the right kidney which was oriented towards the hilum.

     
    Area of Interest: Kidney; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Special Focus: Ischaemia / Infarction;

    Coronal contrast-enhanced computed tomography image after IV contrast administration confirming the presence of this wedge-shaped area on the right kidney also show hemoperitoneum in the left para-colic gutter.

     
    Area of Interest: Kidney; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Special Focus: Haemorrhage; Ischaemia / Infarction;

    CT images before injection of contrast revealed free peritoneal fluid with higher attenuation in the left para-colic gutter. Post contrast images show active bleeding with extravasation of contrast in arterial, portal...

     
    Area of Interest: Abdomen; Imaging Technique: CT-Angiography; Procedure: Contrast agent-intravenous; Special Focus: Haemorrhage;
     
     
  • Figure 4
    Multiple Aneurysms
     

    VRT image with multiple aneurysms of the splenic artery.

     
    Area of Interest: Arteries / Aorta; Imaging Technique: CT-Angiography; Procedure: Contrast agent-intravenous; Special Focus: Aneurysms;

    MIP image with multiple aneurysms of the splenic artery.

     
    Area of Interest: Arteries / Aorta; Imaging Technique: CT-Angiography; Procedure: Contrast agent-intravenous; Special Focus: Aneurysms;

    MIP image with multiple aneurysms of the splenic and gastroomental artery.

     
    Area of Interest: Arteries / Aorta; Imaging Technique: CT-Angiography; Procedure: Contrast agent-intravenous; Special Focus: Aneurysms;

    Catheter arteriography image with multiple aneurysms of the splenic artery.

     
    Area of Interest: Arteries / Aorta; Imaging Technique: Catheter arteriography; Procedure: Angioscopy; Special Focus: Aneurysms;

    Catheter arteriography image with multiple aneurysms of the mesenteric artery.

     
    Area of Interest: Arteries / Aorta; Imaging Technique: Catheter arteriography; Procedure: Angioscopy; Special Focus: Aneurysms;
     
     
Vertical long axis, short axis and four chamber views show hypodense myocardium in the antero-lateral wall an papilary muscle.
 
Vertical long axis, short axis and four chamber views show hypodense myocardium in the antero-lateral wall an papilary muscle.
 
Vertical long axis, short axis and four chamber views show hypodense myocardium in the antero-lateral wall an papilary muscle.
 
Vertical long axis, short axis and four chamber views show hypodense myocardium in the antero-lateral wall an papilary muscle.
 
Coronarography show the first marginal branch of the left circumflex artery (LCX) occluded.
 
Axial contrast-enhanced computed tomography showing a wedge-shaped and sharply demarcated hypodense area on the right kidney which was oriented towards the hilum.
 
Coronal contrast-enhanced computed tomography image after IV contrast administration confirming the presence of this wedge-shaped area on the right kidney also show hemoperitoneum in the left para-colic gutter.
 
CT images before injection of contrast revealed free peritoneal fluid with higher attenuation in the left para-colic gutter. Post contrast images show active bleeding with extravasation of contrast in arterial, portal and late venous phases.
 
VRT image with multiple aneurysms of the splenic artery.
 
MIP image with multiple aneurysms of the splenic artery.
 
MIP image with multiple aneurysms of the splenic and gastroomental artery.
 
Catheter arteriography image with multiple aneurysms of the splenic artery.
 
Catheter arteriography image with multiple aneurysms of the mesenteric artery.
 
 
 
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