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Emergency medicine
Spontaneous hepatic artery pseudoaneurysm rupture as a first presentation of polyarteritis nodosa
  1. Eleni-Anna Verigou1,
  2. Nicola Skajaa1 and
  3. Hitendra Tanwar2,3
  4. Chief Consultant & Clinical Director Urgent and Emergency Services EKHUFTOn behalf of
  1. 1East Kent Hospital Trust, NHS England, Ashford, UK
  2. 2East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
  3. 3Urgent and emergency care [UEC] Acute Medicine, East Kent Hospital University Foundation Trust, Ashford, Kent, UK
  1. Correspondence to Dr Hitendra Tanwar; hitendra.tanwar{at}nhs.net

Abstract

A man in his 70s presented with a sudden onset stabbing back pain radiating to the chest and pre-syncopal symptoms. He underwent urgent investigations, including a CT angiogram aorta which did not reveal any abnormalities within the thorax, abdomen or pelvis and no cause of symptoms was identified. After being discharged, he re-presented 2 days later with syncopal episodes, abdominal pain and a significant drop in haemoglobin levels. This time, a CT mesenteric angiogram showed two hepatic artery pseudoaneurysms and a large haemoperitoneum. Following a hepatic artery embolisation, a workup showed that the likely cause of the pseudoaneurysms was a rare first presentation of polyarteritis nodosa. This case highlights the importance of considering the possibility of an aneurysmal rupture, especially when common causes of an acute abdomen have been excluded, and not relying on previous negative investigations to exclude pathology, as the outcomes can be detrimental.

  • Emergency medicine
  • Interventional radiology
  • Vasculitis

https://doi.org/10.1136/bcr-2023-257411

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    Footnotes

    • E-AV, NS and HT are joint first authors.

    • X @drhisita@yahoo.com

    • Contributors E-AV, NS and HT were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content. E-AV, NS and HT gave final approval of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.