Clinical implications of perivascular fat stranding surrounding spontaneous isolated superior mesenteric artery dissection on computed tomography

Tan, Zhiqiang; Jin, Qi; Fan, Wenliang; Han, Ping; Li, Xin

doi:10.3892/etm.2020.9466

Cited by 4 publications

(7 citation statements)

References 35 publications

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“…The pathogenesis of SISMAD has been undetermined in most reported cases and has yet to be fully elucidated [ 4 , 9 , 23 , 24 ]. Some studies have noted associations with hypertension, smoking, alcohol abuse, trauma, atherosclerosis, cystic medial necrosis, connective tissue diseases and fibromuscular dysplasia [ 6 , 17 , 25 ]. Fibromuscular dysplasia was also associated with renal artery dissection and aortic dissection [ 26 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

“…3 ). [ 2 , 6 , 16 ] The inclusion criteria were isolated lesions and CECT, CTA, or digital subtraction angiography (DSA) imaging data. The exclusion criteria were as follows: i) absence of CECT and CTA data; ii) asymptomatic; iii) recent abdominal trauma; and iv) concomitant aortic dissection.…”

Section: Methodsmentioning

confidence: 99%

“…Prior to 2014, only 622 cases were reported in China [ 5 ]. However, following improvements in diagnostic radiological practices and the wider availability of high-quality computed tomography (CT) angiography (CTA) and contrast-enhanced computed tomography (CECT) in recent years, there has been a dramatic increase in reports of this disease [ 1 , 6 , 7 ]. In the present study, we retrospectively collected all SISMAD cases treated at our hospital between January 2013 and December 2020, and we found that the number of cases also increased over time at our hospital (Fig.…”

Section: Introductionmentioning

confidence: 99%

“…Plain CT is the first examination choice in the emergency department for acute abdominal pain. For SISMAD patients, the findings of plain CT often are negative or are positive but cannot explain the symptoms [ 6 ]. In some SISMAD patients, the findings show an enlarged SMA diameter and/or perivascular exudation, which are often neglected by doctors and radiologists because of insufficient awareness.…”

Section: Introductionmentioning

confidence: 99%

“…The authors emphasized that the higher incidence of SISMAD was likely due to the introduction of CECT for investigating abdominal pain [ 4 ]. Furthermore, even though there was a lack of specificity, an enlarged SMA diameter on plain CT was the most crucial indication for diagnosis or exclusion, which is often neglected by emergency doctors and radiologists because of insufficient awareness [ 6 ]. Only a small number of studies involving few patients have included measurements of the SMA diameter [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Clinical characteristics and misdiagnosis of spontaneous isolated superior mesenteric artery dissection

Lei

Liu

Lin

et al. 2022

BMC Cardiovasc Disord

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Background Spontaneous isolated superior mesenteric artery (SMA) dissection (SISMAD) is a rare disease with a potentially fatal pathology. Due to the lack of specificity of clinical characteristics and laboratory tests, misdiagnosis and missed diagnosis are often reported. Therefore, the aim of this study was to investigate the clinical characteristics and misdiagnosis of SISMAD. Methods In a registry study from January 2013 to December 2020, 110 patients with SISMAD admitted to the First Affiliated Hospital of Wenzhou Medical University were enrolled. Descriptive methods were used to analyse clinical characteristics, laboratory data, diagnostic method or proof, misdiagnosed cases, plain computed tomography (CT) findings and dissection features. To study the relationship between dissection features and treatment modality, the selected patients were classified into the conservative group (n = 71) and the non-conservative group (n = 39). The Chi-square test and Student’s t-test were used to compare the conservative and non-conservative groups. Results One hundred ten patients with SISMAD, including 100 (90.9%) males and 10 (9.1%) females, with a mean age of 52.4 ± 7.6 years, were enrolled in the study. Relevant associated comorbidities included a history of hypertension in 43 cases (39.1%), smoking in 46 cases (41.8%), and alcohol consumption in 34 cases (30.9%). One hundred four patients (94.5%) presented with abdominal pain. Abnormalities in the C-reactive protein lever, white blood cells count and D-dimer lever were the 3 most common abnormal findings. There were 32 misdiagnosis or missed diagnosis. Fourteen cases were misdiagnosed because of insufficient awareness. Twelve cases were misdiagnosed because of disease features. Twenty cases were misdiagnosed as SMA embolism. Among them, There were 15 cases of Yun type IIb SISMAD. Sixty-six patients underwent plain CT. The maximum SMA diameter was 12.1 (11.3–13.1) mm, and the maximum SMA diameter was located on the left renal vein (LRV) plane in 68.2% of cases. Dissection features observed on contrast-enhanced CT (CECT), CT angiography (CTA), or digital subtraction angiography (DSA) showed that there were 70 cases (63.6%) of Yun type IIb SISMAD, the maximum SMA diameter was 13.0 ± 2.4 mm, the location of the maximum SMA diameter was on the LRV plane in 64.5% of cases, and 7.3% of cases were complicated with intestinal obstruction, including bowel necrosis in 3.6% of cases. There were differences between the conservative group and non-conservative groups in the residual true lumen diameter or degree of true lumen stenosis and the presence of intestinal obstruction or bowel necrosis (all P < 0.05). Conclusion For SISMAD, misdiagnosis and missed diagnosis were usually caused by insufficient awareness and disease features. SISMAD should be considered in the differential diagnosis of patients presenting with unexplained abdominal pain, especially males, patients in the 5th decade of life, patients with hypertension, and patients with an enlarged SMA diameter or a maximum SMA diameter located on the LRV plane on plain CT. Mesenteric CTA or CECT should be recommended for the investigation of these conditions.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical characteristics and misdiagnosis of spontaneous isolated superior mesenteric artery dissection

Lei

Liu

Lin

et al. 2022

BMC Cardiovasc Disord

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Value of CT angiography in diagnosis and classification of spontaneous isolated superior mesenteric artery dissection and evaluation of its clinical symptoms

Ding¹,

Su²

2023

WCJD

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Current status of spontaneous isolated celiac artery dissection

Han

et al. 2022

Vascular

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Background This study aimed to evaluate the current status of spontaneous isolated celiac artery dissection (SICAD). Methods The English-language literature published in various databases before December 2020 was reviewed. All case reports and series were included. If multiple reports came from the same hospital and covered the same period, only the most recent report was considered. The clinical characteristics, imaging features, and treatment outcome were analyzed. Results The study enrolled 88 English language publications between January 1959 and December 2020, including 70 case reports, two case series, and 16 clinical studies. Overall, 316 cases of SICAD were reported in the studies, including 268 men and 44 women (unavailable for 4, men: women ratio: 6:1, p < 0.05). The median age was 50.5 years (range: 6–72) in men and 53.9 years (range: 41–67) in women. Most patients (83.54%, 264/316) complained about stomach pain, primarily in the epigastric region (38.61%, 122/316). The misdiagnosis rate in this study was 3.16% (10/316). The most commonly used imaging modality was computed tomography angiography (CTA), with 97.47% (308/316) cases reporting its use in diagnosis and/or management. The rate of symptom improvement with Conservative Management, with or without antithrombotic agents, was 92.45% (98/106) and 96.58% (141/146), respectively. The rate of symptom improvement after surgical recanalization was 100% (13/13). Moreover, endovascular management resulted in a 100% (50/50) symptom improvement rate. Conclusion Conservative management is the first-line treatment for SICAD. The surgical or endovascular intervention had a high technical success rate, suggesting that it should be reserved for patients who have failed conservative treatment.

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Clinical implications of perivascular fat stranding surrounding spontaneous isolated superior mesenteric artery dissection on computed tomography

Cited by 4 publications

References 35 publications

Clinical characteristics and misdiagnosis of spontaneous isolated superior mesenteric artery dissection

Clinical characteristics and misdiagnosis of spontaneous isolated superior mesenteric artery dissection

Value of CT angiography in diagnosis and classification of spontaneous isolated superior mesenteric artery dissection and evaluation of its clinical symptoms

Current status of spontaneous isolated celiac artery dissection

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