Imaging recommendation · Vascular

Multi-system vasculitis with renal / GI / neurologic involvement, suspected polyarteritis nodosa

Q: What's the alternative imaging for multi-system vasculitis with renal / gi / neurologic involvement, suspected polyarteritis nodosa when catheter angiography for definitive diagnosis?

Selective visceral angiography (iv contrast).

Q: What's the alternative imaging for multi-system vasculitis with renal / gi / neurologic involvement, suspected polyarteritis nodosa when tissue diagnosis?

Biopsy of affected organ (sural nerve, muscle) (no contrast).

Recommended: CT or MR Angiogram Abdomen (microaneurysms in renal / mesenteric) is the preferred imaging study for multi-system vasculitis with renal / gi / neurologic involvement, suspected polyarteritis nodosa. Necrotizing vasculitis of medium vessels.

Recommended study

CT or MR Angiogram Abdomen (microaneurysms in renal / mesenteric)

CT IV contrast Preferred Vascular OutpatientAcute inpatient Reviewed 2026-05

Necrotizing vasculitis of medium vessels. Hepatitis B associated in some cases.

If the default doesn't apply

Catheter angiography for definitive diagnosis

Selective visceral angiography IV contrast

Tissue diagnosis

Biopsy of affected organ (sural nerve, muscle) No contrast

Watch-outs

Microaneurysm rupture

Spontaneous hemorrhage (perinephric, intraperitoneal) is feared complication.

Pearls

Renal, mesenteric, and hepatic microaneurysms on angiography.
Spares pulmonary vessels (unlike ANCA-associated vasculitis).
Treatment: steroids + cyclophosphamide; antiviral if HBV-associated.