Authors Dr Seren Peters ST2 Radiology Dr Bruce Fox Consultant Radiologist Affiliations Dr Richard Riordan Consultant Radiologist Case synopsis 61 year old male with a background of previous anterior resection in 2017 for sigmoid adenocarcinoma and previous Aortic type A dissection repair ID: 931996
Download Presentation The PPT/PDF document "Isolated Superior Mesenteric Artery Diss..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Isolated Superior Mesenteric Artery Dissection
Authors: Dr Seren Peters, ST2 Radiology, Dr Bruce Fox, Consultant Radiologist
Affiliations: Dr Richard Riordan, Consultant Radiologist
Slide2Case synopsis
61 year old male with a background of previous anterior resection in 2017 for sigmoid adenocarcinoma, and previous Aortic type A dissection repair in 2016.
The patient presented to the hospital having not opened their bowels or passed flatus for two days, with a tender and distended abdomen. The clinical team requested a CT abdomen and pelvis to rule out obstruction.
The portal venous phase CT abdomen showed no evidence of obstruction, and no other abnormality of the bowel found including at the site of anastomosis.
T
he only abnormality identified in the abdomen was some minor fat stranding around the SMA. There was the suggestion of subtle intravascular low attenuation and it was postulated that it may represent thrombus, with the caveat that this was not a dedicated angiographic study and the appearances may be secondary to the portal venous phase of the study.
A CT angiogram was recommended to clarify appearances. Whilst the patient’s pain had since settled, CT angiogram was performed later the same day. The angiogram demonstrated an isolated superior mesenteric artery dissection, with an intimal flap arising from the proximal vessel approximately 2 cm from origin and extending approximately 8 cm along the length of the vessel. At least one major branch (thought to be one of the
pancreatico
-duodenal arteries) was seen to arise from the false lumen. There was no associated aortic dissection, and no further abnormality was identified.
Slide3Fig. 1 Axial section portal-
venous
phase abdomen.
Hypodensity and fat stranding around the mid-SMA.
Fig. 2 Axial
arterial
phase abdomen. Dissection
flap
seen in the lumen of the SMA with associated fat stranding.
Fig. 3 Sagittal section portal-venous phase abdomen. Hypodensity within the SMA lumen and associated fat stranding.
Fig. 4 Sagittal section
arterial
phase abdomen. Dissection
flapand
intramural
haematoma
seen
in the lumen of the SMA
with
associated
fat stranding.