Unusual computed tomography findings of gas in the superior mesenteric artery system with no signs of porto-mesenteric venous gas in a case of acute mesenteric ischemia

Federica Giulio, MD; Sergio Ruggiero, MD; Simone Vicini, MD; Davide Bellini, MD, PhD; Marco Rengo, MD, PhD; Iacopo Carbone, MD, PhD

Radiology Case Reports (Jul 2022)

Unusual computed tomography findings of gas in the superior mesenteric artery system with no signs of porto-mesenteric venous gas in a case of acute mesenteric ischemia

Federica Giulio, MD,
Sergio Ruggiero, MD,
Simone Vicini, MD,
Davide Bellini, MD, PhD,
Marco Rengo, MD, PhD,
Iacopo Carbone, MD, PhD

Affiliations

Federica Giulio, MD: Department of Radiological Sciences, Oncology and Pathology, ''Sapienza'' University of Rome – I.C.O.T. Hospital, Via Franco Faggiana, 1668, 04100, Latina, Italy
Sergio Ruggiero, MD: Department of Radiological Sciences, Oncology and Pathology, ''Sapienza'' University of Rome – I.C.O.T. Hospital, Via Franco Faggiana, 1668, 04100, Latina, Italy
Simone Vicini, MD: Corresponding author.; Department of Radiological Sciences, Oncology and Pathology, ''Sapienza'' University of Rome – I.C.O.T. Hospital, Via Franco Faggiana, 1668, 04100, Latina, Italy
Davide Bellini, MD, PhD: Department of Radiological Sciences, Oncology and Pathology, ''Sapienza'' University of Rome – I.C.O.T. Hospital, Via Franco Faggiana, 1668, 04100, Latina, Italy
Marco Rengo, MD, PhD: Department of Radiological Sciences, Oncology and Pathology, ''Sapienza'' University of Rome – I.C.O.T. Hospital, Via Franco Faggiana, 1668, 04100, Latina, Italy
Iacopo Carbone, MD, PhD: Department of Radiological Sciences, Oncology and Pathology, ''Sapienza'' University of Rome – I.C.O.T. Hospital, Via Franco Faggiana, 1668, 04100, Latina, Italy

Journal volume & issue: Vol. 17, no. 7
pp. 2568 – 2572

Abstract

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Acute Mesenteric Ischemia (AMI) is a rare life-threatening entity caused by sudden interruption of the blood supply to a segment of the bowel due to impairment of mesenteric arterial blood flow or venous drainage. Clinical presentation varies according to the time course of vascular occlusion. Contrast-enhanced Computed Tomography (CT) of the abdomen represents the main diagnostic test for AMI diagnosis, enabling fast and excellent evaluation of the intestine, mesenteric vasculature, and other ancillary characteristics of AMI. Typical CT findings of AMI include paralytic ileus, decreased or absent bowel wall contrast-enhancement, pneumatosis intestinalis, and porto-mesenteric venous gas. We hereby report a case of an 89-year-old man presenting with AMI due to Superior Mesenteric Artery (SMA) thrombotic occlusion following endovascular stenting superficial femoral arteries. Typical findings were observed on abdominal CT imaging, yet associated with the presence of gas exclusively in the SMA district, without any involvement of the porto-mesenteric venous system. Different imaging features and pitfalls can help radiologists to accurately diagnose AMI, especially when irreversible bowel damage is about to occur. Therefore, radiologists and emergency physicians should be aware of the unusual association between gas in the SMA arterial district and AMI, even in the absence of porto-mesenteric venous system involvement, in order to urge prompt surgical consultation when observed.

Published in Radiology Case Reports

ISSN: 1930-0433 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Medicine (General): Medical physics. Medical radiology. Nuclear medicine
Website: https://www.sciencedirect.com/journal/radiology-case-reports

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