PATHOLOGICAL FINDING

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=22 BGCOLOR="#FFFFFF" TEXT="#080000" bgproperties="fixed" background="041000d2egerdp.gif"> <div> </div> </td> </tr><tr> <td valign="top" width=145 BGCOLOR="#333399" TEXT="#080000" background="040a2c00erkjzj.gif"> <div>  <img src="HTMLobj-127/aniGif.gif" border="0" align="bottom" width="82" height="75">   <img src="HTMLobj-128/aniGif.gif" border="0" align="bottom" width="55" height="126">   <img src="HTMLobj-129/aniGif.gif" border="0" align="bottom" width="92" height="120">  </div> </td> <td valign="top" height=458 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <FONT SIZE="5" COLOR="#336600" FACE="Times New Roman" ><I>POLYARTERITIS NODOSA</I></FONT><FONT SIZE="1" COLOR="#663399" FACE="Times New Roman" >    </FONT> |    <B> </B><FONT SIZE="2" COLOR="#0000BF" FACE="Times New Roman" ><A HREF="index.htm" TARGET="_top" TITLE="POLYARTERITIS NODOSA"><U><B>home</B></U></A></FONT></div> <div> <A HREF="id17.htm" TARGET="_top" TITLE="DEFINITION AND GENERALITY"><U>DEFINITION AND GENERALITY</U></A>   |   <B>PATHOLOGICAL FINDING</B>   |   <A HREF="id24.htm" TARGET="_top" TITLE="clinic"><U>clinic</U></A>   |   <A HREF="id22.htm" TARGET="_top" TITLE="vascularitis"><U>vascularitis</U></A>   |   <A HREF="id23.htm" TARGET="_top" TITLE="pictures"><U>pictures</U></A>   |   <A HREF="id20.htm" TARGET="_top" TITLE="MORE TO KNOW"><U>MORE TO KNOW</U></A>   |   <A HREF="id21.htm" TARGET="_top" TITLE="references"><U>references</U></A>   |   <A HREF="id19.htm" TARGET="_top" TITLE="Contact Me"><U>Contact Me</U></A></div> <div> <IMG SRC="04207040.gif" border=0 width="263" height="4" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> <B>PATHOLOGICAL FINDING</B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> <img src="HTMLobj-126/aniGif.gif" border="0" align="bottom" width="120" height="130">  Segmental, necrotizing inflammation of media and adventitia characterizes the lesion.</B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> The pathologic process most commonly occurs at points of vessel bifurcation, beginning in the media and extending into the intima and adventitia of medium-sized arteries, often disrupting the internal elastic lamellae. </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Lesions usually occur in all stages of development and healing. </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Early lesions contain PMNs and occasionally eosinophils; </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">later lesions contain lymphocytes and plasma cells. Immunoglobulin, complement components, and fibrinogen are deposited in the lesions, but their significance is unclear.</B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> Intimal proliferation with secondary thrombosis and occlusion leads to organ and tissue infarction. </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Weakening of the muscular vessel wall may cause small aneurysms and arterial dissection. </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Healing can result in nodular fibrosis of the adventitia.</B></div> <bR> <bR> <div> <B><IMG SRC="07412fe0.gif" border=0 width="530" height="510" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <bR> <div> <B> <TABLE BORDER="2" CELLPADDING="2" CELLSPACING="1" WIDTH="826" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" BGCOLOR=#FFFF66 > <tR> <tD VALIGN=TOP HEIGHT= 543 WIDTH="814"><div> <B>Renal, hepatic, cardiac, and GI involvement</B> is most frequent. </div> <div> Renal lesions are of two types: large-vessel (the lesion is a tubular infarction, and renal failure is uncommon) and microvascular, including the glomerular afferent arterioles (the lesion is diffuse, and renal failure is common and occurs early). </div> <bR> <div> Of patients with massive hepatic infarction, 50% have polyarteritis nodosa, although this complication is rare.</div> <bR> <div>  Milder degrees of hepatic tenderness and increased concentrations of liver enzymes usually reflect focal areas of hepatic capsular vasculitis.</div> <div>  <A NAME="a005_050_0261"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></div> <div> Several polyarteritis nodosa-associated syndromes are separated from typical polyarteritis nodosa by pathogenic or clinical differences: </div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">hypersensitivity angiitis; </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Churg-Strauss syndrome (the vasculitis includes lung involvement, </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">eosinophilia,</B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> necrotizing granulomas, </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">and severe asthma); </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Cogan's syndrome (the disease begins as interstitial keratitis and inner ear infarction); </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">pure mesenteric polyarteritis nodosa (recognized in IV methamphetamine addicts);</B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> Kawasaki's disease (mucocutaneous lymph node syndrome in infants and children complicated by coronary arteritis with early aneurysm formation);</B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> and necrotizing arteritis associated with hepatitis B infection (either acute hepatitis or chronic active liver disease).</B></div> <bR> <bR> <div>  Many patients with essential cryoglobulinemia causing small- and medium-sized vasculitis (ie, palpable purpura, digital vessel occlusion, glomerulonephritis) are chronically infected with hepatitis C. </div> <div> The interrelationships of idiopathic polyarteritis nodosa and these forms of arteritis are unclear.</div> <bR> </tD> </tR> </TABLE></B></div> <bR> </td> </tr></table></body>