Massive intrahepatic hemorrhage as first manifestation of polyarteritis nodosa.

A case of an acute abdomen caused by a massive intrahepatic hemorrhage in a 77-year old man is presented. The hemorrhage was the first manifestation of an underlying polyarteritis nodosa which had not been diagnosed prior to the event. The diagnosis was suspected after a preoperatively performed angiography, surgical treatment was required to control the bleeding. This case demonstrates the differential diagnosis of acute intrahepatic hemorrhage which includes rare causes of vasculitis.