结节性多动脉炎并发双肾多发动脉瘤破裂出血1例报告

A case report of polyarteritis nodosa accompany with renal multiple aneurysms rupture hemorrhage

回顾性分析1例以发热、大量血尿为主要症状的结节性多动脉炎患者的诊治经过。患者,男,58岁,因发热、头痛、乏力等多系统症状就诊,诊断为发热原因待查、肺部感染、胆囊炎、低白蛋白血症,予抗感染、补充白蛋白等对症治疗。3周后出现严重血尿,影像学检查提示右肾盂积血、心包、胸腔积液,增强CT检查示:腹主动脉分支、双肾和胰腺动脉多发小动脉瘤,明确结节性多动脉炎诊断。予糖皮质激素和免疫抑制剂治疗,同时行高选择性肾动脉栓塞术。术后血尿有效控制,全身状况改善。随访2个月,患者病情稳定。

A case of polyarteritis nodosa was reviewed.The patient was a 58-year-old middle-aged man.He developed fever,headache,fatigue and other symptoms.Three weeks after,massive hematuria was seen.CT plain scan and MRI indicated blood clots in renal pelvis,and pericardium and pleural effusion.Renal arteriography indicated multiple venous fistula in both kidneys.Enhanced CT scan showed multiple small aneurysms in abdominal aortic branches,bilateral renal arteries and pancreatic arteries.The diagnosis of nodular polyarteritis was confirmed.Glucocorticoid and immunosuppressive agents were given.Meanwhile,highly selective renal arteriovenous fistula embolization was performed,Postoperative hematuria was effectively controlled,and the general condition was gradually improved.The patient was followed up for 2 months,and the condition was stable.