Purpose or Case Report: Pediatric polyarteritis nodosa (PAN) is a rare systemic vasculitis affecting medium-sized arteries, leading to inflammation and organ damage. It often involves the skin, kidneys, and gastrointestinal tract, with symptoms such as fever, abdominal pain, and hypertension. Early diagnosis and treatment are essential to managing this condition. This report discusses renal imaging findings in two pediatric patients with PAN.

A 10-year-old male presented with abdominal pain, nausea, and acute renal failure. A left renal biopsy revealed medium vessel arteritis, raising suspicion for polyarteritis nodosa. Renal Doppler ultrasound showed normal renal arteries but increased echogenicity of the kidneys. CTA demonstrated patent renal arteries without beading, but bilateral cortical hypoenhancement was observed, indicating cortical necrosis consistent with vasculitis. MRA further confirmed the suspicion of PAN by revealing minimal contrast blushing and nodularity at the corticomedullary junction, suggestive of microaneurysms. Imaging played a key role in confirming the diagnosis of PAN in this patient.

A 16-year-old male presented with a six-month history of abdominal pain, fatigue, weight loss, chills, and hypertension. Laboratory results showed elevated inflammatory markers. MRA of the chest, abdomen, and pelvis revealed numerous bilateral arterial enhancing foci within the renal parenchyma, measuring 2 to 5 mm, suggestive of microaneurysms. A renal biopsy confirmed secondary focal segmental glomerulosclerosis.

CT and MR imaging are essential for diagnosing pediatric polyarteritis nodosa by identifying key vascular abnormalities such as microaneurysms and ischemic damage. These imaging techniques not only confirm the diagnosis but also guide timely intervention, improving the management of this rare condition in pediatric patients.
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