I solated spontaneous dissection of the celiac artery is reportedly rare, and even rarer when unaccompanied by aortic dissection. We report the finding of an isolated spontaneous dissection of the celiac artery in a patient with von Willebrand disease, and our diagnostic use of computed tomography (CT) and CT angiography in this case.
Case ReportIn March 2011, a 47-year-old man was admitted to our hospital because of persistent, dull pain in the upper left quadrant of the abdomen. The pain started after the patient ate, and it gradually worsened. About a week before admission, he had sharp epigastric pain that radiated to his back and lasted for approximately 10 minutes. He reported no fever, nausea, vomiting, rectal bleeding, melena, or dysuria. He had von Willebrand disease, upper gastrointestinal bleeding secondary to nonsteroidal drug use, trigeminal neuralgia, and no history of iatrogenic injury from instrumentation or trauma.The patient's vital signs were stable. Abdominal examination revealed left upper quadrant tenderness without guarding or rigidity. Initial laboratory data included a hemoglobin level of 16.5 g/dL, a white blood cell count of 10,700 cells/mm 3 with a normal differential count, a C-reactive protein level of 4.3 mg/L, an erythrocyte sedimentation rate of 23 mm/hr, and a normal partial thromboplastin time and prothrombin time. Further results were negative for autoimmune disease or vacuities. Contrast-enhanced CT of the abdomen and pelvis revealed an infarct in the posterior third of the spleen (Fig. 1), an opacified segmental branch of a splenic artery, and an eccentric thrombus and focal dissection involving the celiac artery with surrounding fat-stranding (Fig. 2). The dissection was also seen in the common hepatic artery (CHA). Computed tomographic angiograms revealed a normal aorta and an intimal flap within the celiac artery that extended into the splenic artery and the CHA, with small areas of thrombus along the left lateral wall of the celiac artery and the posterior wall of the CHA. The patient was discharged from the hospital on low-dose aspirin therapy, with follow-up CT angiography scheduled in 3 months.
DiscussionContrast-enhanced CT is the primary technique for diagnosing celiac artery dissection; magnetic resonance imaging, magnetic resonance angiography, Doppler ultrasonography, and conventional angiography can also be used. On contrast-enhanced CT, findings might include an intimal flap, mural thrombus with or without aneurysmal dilation, segmental stenosis, and infiltration of the fat surrounding the vessel.
