Fatal vasculitis (periarteritis nodosa) of the coronary arteries: Angiographic ambiguities and absence of aneurysms at autopsy

Abstract

A 30 year old man died during coronary artery bypass grafting for presumed premature atherosclerotic coronary disease. Autopsy revealed vasculitis with characteristics of periarteritis nodosa of the coronary arteries with severe luminal narrowing, but without aneurysms. This is the first report of a patient with these findings studied angiographically and at autopsy.

Polyarteritis nodosa presenting as acute myocardial infarction with coronary dissection

“…Clinical evidence supporting the diagnosis of PAN included history of peptic ulcer disease with gastrointestinal bleeding, persistent low grade fever, pleuritic chest pain, normochromic, normocytic anemia with hematocrit 30%, and erythrocyte sedimentation rate of 58 mm/hour initially and 120 mm/hour 22 days later. Cassling et al [6] described a 30-year-old female smoker who presented with intermittent chest pain and strongly positive stress test. Coronary angiography revealed severe luminal narrowing of several coronary arteries without aneurysm formation.…”

Coronary Angiography

“…The incidence of coronary vasculitis is probably underestimated by angiography because the fi ndings are so similar to atherosclerosis [ 508 ]. In young patients with systemic lupus erythematosus and no important risk factors for atherosclerosis, coronary lesions and myocardial infarction should be assumed to be due to vasculitic involvement of the coronary arteries until shown otherwise, although accelerated atherosclerosis due to corticosteroid therapy may also account for angiographically detected lesions.…”

Coronary Artery Aneurysms: An Update

“…Pick et al (1982) have reported a 26-year-old woman who, during cardiac catheterization, revealed numerous aneurysms involving all three coronary vessels that were particularly worse in the distal RCA. Cassling et al (1985) have described a 30-year-old female smoker who presented with intermittent chest pain and a strongly positive stress test. Coronary angiography revealed severe luminal narrowing of several coronary arteries without aneurysm formation.…”