Ann Surg Treat Res.  2014 Nov;87(5):273-275. 10.4174/astr.2014.87.5.273.

Polyarteritis nodosa presented as a dilatation of the intrahepatic bile duct

• Choi HL
• Sung RH
• Kang MH
• Jeon HJ
• Yun HY
• Jang LC
• Choi JW
• Song YJ
• Ryu DH

• KMID: 2266887
• DOI: http://doi.org/10.4174/astr.2014.87.5.273

Abstract

Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis of small- and medium-sized arteries in multiorgan systems. PAN may affect the gastrointestinal tract in 14%-65% of patients, but rarely involves the biliary tract and liver. We describe a patient without underlying disease who was diagnosed with PAN during resection of the gallbladder and liver.

Keyword

Polyarteritis nodosa; Liver; Intrahepatic bile duct; Biliary stone; Gallbladder

MeSH Terms

Arteries
Bile Ducts, Intrahepatic*
Biliary Tract
Dilatation*
Gallbladder
Gastrointestinal Tract
Humans
Liver
Polyarteritis Nodosa*
Vasculitis

Figure

• 

  Fig. 1 Contrast enhanced abdominal CT shows focal left intrahepatic duct dilatation with some narrowing portions (arrows).

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  Fig. 2 (A) T2-weighted magnetic resonance image shows focal left intrahepatic duct dilatation. (B) Enhanced T1-weighted magnetic resonance image showed no abnormal enhanced lesion in liver. (C) Magnetic resonance cholangiopancreatography shows focal left intrahepatic duct dilatation with luminal narrowing (white arrows).

• 

  Fig. 3 A large portal tract expanded with distended bile ducts due to hepatolithiasis. Shown above are small-to-medium sized arteries with transmural inflammation and/or transmural fibrosis (arrows) (H&E, ×10).

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  Fig. 4 In this microphotograph, one small artery shows transmural inflammation (A) and one medium artery shows transmural fibrosis with thickening of the wall (B). All other arteries are normal in appearance (H&E, ×40).

• 

  Fig. 5 At higher magnification of Fig. 2A, transmural infiltration of small artery by mononuclear cells, neutrophils, and eosinophils is accompanied by fibrinoid necrosis (arrow) (H&E, ×200).

Reference

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