Clinical diagnosis of segmental arterial mediolysis: Differentiation from vasculitis and other mimics

A rare case of segmental arterial mediolysis

“…The most common site of vessel involvement are the visceral mesenteric arteries. Radiographic features and angiographic findings are arterial dilatation, arterial stenosis, single and multiple aneurysms (string of beads appearance), dissecting hematomas and arterial thrombosis [4,9]. These imaging findings reflect the histological changes of the disease.…”

Segmental arterial mediolysis mimics systemic vasculitis

“…Surgical treatment is required in patients with recurrent bleeding or in whom embolization has failed. Many authors recommend to monitor the patients with SAM who undergo arterial embolization at short intervals to evaluate the changes in the lesions (4,10).…”

Acute Remodeling of an Adjoining Aneurysm after Endovascular Treatment of a Ruptured Splanchnic Arterial Aneurysm: A Case of Clinically Diagnosed Segmental Arterial Mediolysis

“…For the patients with multiple SAAs and irregular splanchnic arterial dilatation as observed in our patient, the presence of following peculiar systemic backgrounds should be suspected, such as: SAM, fibromuscular dysplasia (FMD), polyarteritis nodosa, ANCA-associated vasculitis, giant cell arteritis, Takayasu arteritis, Behcet's disease, Kawasaki disease, infection, Ehlers-Danlos syndrome type IV, Marfan's syndrome, neurofibromatosis, pseudoxanthoma elasticum, and atherosclerosis. 7) From these diseases, we excluded vasculitis, infection, and atherosclerosis from the differential diagnosis in our case. Furthermore, diseases of genetic origin were also excluded in our case owing to the lack of specific clinical features and family history.…”

“…Although histological examination is the gold standard for the diagnosis of SAM, 4) and the criteria for the clinical diagnosis of SAM are yet to be established, radiological findings sometimes contribute to the clinical diagnosis of SAM after excluding other suspected systemic diseases. [6][7][8][9] Herein, we report the case of a patient who had multiple SAAs without any atherosclerotic, inflammatory, or hereditary causes; one of the SAAs showed intra-abdominal hemorrhage. After coil embolization of the responsible arteries, an adjacent SAA showed unexpected rapid enlargement and was successfully treated with endovascular therapy.…”