A C ase of T runco ‐A rteritis D iffusa P roductiva (S o ‐C alled P ulseless D isease )

Summary The lesions of this disease are seen mainly in the trunks of larger and medium sized arteries where focal coagulation necrosis and granuloma consisting of epithelioid cells and giant cells of Langhans type occur primarily, and these focal changes extend to the surrounding area forming irregular scar tissues and in turn cause a diffuse productive inflammation of the arterial walls. Such lesions seem to begin centering at the vasa vasorum in adventitia and media, and changes in the intima or formation of thrombi are interpreted to be secondary. It is important to note that marked thickening of the arterial wall in some portions is found immediately after branching off, while no changes are visible proximal to the branching. From these findings it is proposed that the preferable designation for this disease is T runco‐arteritis D iffusa (or G ranulomatosa ) P roductiva . In this case, marked stenosis due to thickening of the wall of the left subclavian artery causes an absence of radial pulsation of this side, that of the renal arteries brings about degenerative changes in both kidneys, and marked stenosis of the short gastric arteries causes an ischemic necrosis of the stomach wall, through which perforations occur. Atypical tubercle bacilli of viral type are suspected as the etiologic factor of this disease. In has been said that this disease occurs most frequently among women in puberty, and therefore, this is the first autopsy report of a boy in the first decade such as 5 years of age.