A 46-year-old man presents with weight loss, abdominal pain, hypertension, livedo reticularis and mononeuritis multiplex. He is hepatitis B surface antigen positive. Mesenteric angiography is planned. Which angiographic finding would be MOST supportive of the diagnosis?

• A Coronary ectasia involving all three epicardial arteries
• B Beading of intracranial vessels with alternating stenosis and dilatation
• C Diffuse narrowing of the aortic arch and its major branches
• D Microaneurysms of renal and mesenteric arteries ✓

Explanation

Polyarteritis nodosa is a necrotising vasculitis of medium-sized muscular arteries strongly associated with hepatitis B infection. Segmental transmural fibrinoid necrosis weakens the vessel wall producing multiple microaneurysms (up to 1 cm) of the renal, mesenteric and hepatic arteries, giving the classic rosary bead appearance on angiography. Aortic arch narrowing suggests Takayasu arteritis, and beading of intracranial vessels suggests primary CNS vasculitis or fibromuscular dysplasia.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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