title: Segmental arterial mediolysis: report of 2 cases and review of the literature.
abstract: Segmental arterial mediolysis (SAM) is an idiopathic noninflammatory vasculopathy involving small to medium arteries, usually in the abdomen, although arteries in the cerebral and coronary circulations also may be affected. Some cases present as abdominal apoplexy due to aneurysmal rupture, but ischemia and infarction also occur. Not uncommonly, SAM may be misdiagnosed as a systemic necrotizing vasculitis. We present 2 patients with bilateral renal infarctions, cerebral arterial dissections, and visceral artery microaneurysms. Both were diagnosed initially as polyarteritis nodosa. The diagnosis was changed to SAM, in one case based on clinical and radiologic features, and in the other, on an open wedge kidney biopsy. We discuss the differential diagnosis and review the literature on SAM.
authors.affiliation: Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA. kidneys@comcast.net
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Filippone
authors.forename: Andrew
authors.initials: A
authors.lastname: Foy
authors.forename: Taki
authors.initials: T
authors.lastname: Galanis
authors.forename: Marian
authors.initials: M
authors.lastname: Pokuah
authors.forename: Eric
authors.initials: E
authors.lastname: Newman
authors.forename: Costas D
authors.initials: CD
authors.lastname: Lallas
authors.forename: Carin F
authors.initials: CF
authors.lastname: Gonsalves
authors.forename: John L
authors.initials: JL
authors.lastname: Farber
mesh_terms: D000328:Adult; D000783:Aneurysm / Q000473:pathology*; D000784:Aortic Dissection / Q000473:pathology; D001158:Arteries / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007238:Infarction / Q000000981:diagnostic imaging / Q000473:pathology*; D007668:Kidney / Q000098:blood supply*; D010488:Polyarteritis Nodosa / Q000175:diagnosis; D011860:Radiography, Abdominal; D012077:Renal Artery / Q000473:pathology*; D014057:Tomography, X-Ray Computed