Could CT finding of gas in the sole mesenteric artery be a sign of a severe acute ischemia? Presentation of a rare fatal case and a literature review

Valerio D'Agostino, MD; Luigi Coppola, MD; Angela Barillaro, MD; Mariateresa Spaziano, MD; Nicola Bonacci, MD; Stefania Castaldo, MD; Ciro Nappa, MD; Giovanna Iacuessa, MD; Fabio Cerrone, MD; Antonio Salzano, MD

Radiology Case Reports (Oct 2023)

Could CT finding of gas in the sole mesenteric artery be a sign of a severe acute ischemia? Presentation of a rare fatal case and a literature review

Valerio D'Agostino, MD,
Luigi Coppola, MD,
Angela Barillaro, MD,
Mariateresa Spaziano, MD,
Nicola Bonacci, MD,
Stefania Castaldo, MD,
Ciro Nappa, MD,
Giovanna Iacuessa, MD,
Fabio Cerrone, MD,
Antonio Salzano, MD

Affiliations

Valerio D'Agostino, MD: Department of Radiology, Sessa Aurunca Hospital, Sessa Aurunca, Caserta, Italy; Corresponding author.
Luigi Coppola, MD: Department of Radiology, Maddaloni Hospital, Caserta, Italy
Angela Barillaro, MD: Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
Mariateresa Spaziano, MD: Department of Radiology, Sessa Aurunca Hospital, Sessa Aurunca, Caserta, Italy
Nicola Bonacci, MD: Department of Radiology, Sessa Aurunca Hospital, Sessa Aurunca, Caserta, Italy
Stefania Castaldo, MD: Department of Radiology, University of Trieste, ASUGI, Cattinara Hospital, Trieste, Italy
Ciro Nappa, MD: Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
Giovanna Iacuessa, MD: Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
Fabio Cerrone, MD: Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
Antonio Salzano, MD: Department of Radiology, Sessa Aurunca Hospital, Sessa Aurunca, Caserta, Italy

Journal volume & issue: Vol. 18, no. 10
pp. 3390 – 3394

Abstract

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Contrast-enhanced abdominal CT is the gold standard for the diagnosis of acute mesenteric ischemia (AMI). CT findings include several anomalies like bowel wall thickening, thinning, attenuation, decreased enhancement, dilated fluid-filled loops, pneumatosis, and portal venous gas. A rare case of gas found only in the superior mesenteric artery (SMA) is presented. A contrast-enhanced CT scan was performed in emergency on an 80-year-old man with vague and diffuse abdominal pain, which showed findings of occlusive AMI. Gas was found in the context of the SMA and its branches, but not in the mesenteric and portal veins. The patient underwent emergency surgery but he died the next day in the intensive care unit for complications. The rare CT finding of gas in SMA during an AMI should be considered a radiological sign of irreversible intestinal damage: surgical prompt intervention is needed, even if the mortality rate is high.

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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