Necrotizing Angiitis: II. Findings at Autopsy in Twenty-Seven Cases

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IN the study of inflammatory lesions of blood vessels, some basic problems have remained unsolved since Rokitansky first described the gross pathologic features of the lesions in 1852 (cited by Zeek1). Widely varying views are held on the classification of this group of disorders in spite of the extensive literature on the subject. The differentiation of polyarteritis nodosa from the vascular lesions designated by Zeek and associates2 as hypersensitivity angiitis has stimulated many of the recent studies. Some authors2–4 clearly distinguish polyarteritis nodosa from hypersensitivity angiitis, while others 5, 6 do not. Nosology of the significant vascular changes found in Wegener’s granulomatosis,7 allergic granulomatosis,8 and a variety of less well defined generalized vascular diseases9, 10 is also controversial.

Experimental data have failed to elucidate clearly the basic mechanisms in this perplexing disease group, and the morphologic examination of material from human beings remains a significant method of study. With these considerations in mind it was believed that a review of the autopsy findings in cases of these disorders would be valuable. From a review of the records of all autopsies performed here between 1942 and 1964, 27 cases of necrotizing angiitis were selected. The series of 27 cases was divided into three types: (1) polyarteritis nodosa, (2) hypersensitivity angiitis, and (3) Wegener's granulomatosis. The term ‘necrotizing angiitis’ is used to suggest that the fundamental process is vascular and not secondary to disease of other organ systems.

We have previously reported the clinical features of this group of cases.11

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