Clinically Suspected Segmental Arterial Mediolysis of the Splanchnic Arteries: A Report of 2 Rare Cases

Abstract

Case series Patients: Female, 89-year-old • Male, 52-year-old Final Diagnosis: Segmental arterial mediolysis Symptoms: Abdominal pain • bleeding Medication: — Clinical Procedure: — Specialty: Radiology Objective: Rare disease Background: Segmental arterial mediolysis (SAM) is an uncommon vascular pathology characterized by arteriopathy, mainly of medium-sized abdominal splanchnic vessels, without an atherosclerotic, inflammatory, infectious, or autoimmune underlying etiology. Segmental arterial mediolysis is clinically heterogeneous and symptoms may be completely nonspecific. The knowledge of radiological features of segmental arterial mediolysis and the exclusion of other pathologies should direct early diagnosis and refer patients for correct treatment. Case Report: In the last 2 years, we treated 2 different adult patients (an 89-year-old woman and a 52-year-old man) with spontaneous visceral bleeding, admitted to the Emergency Department due to acute onset of abdominal pain, anemia, and computed tomographic angiography (CTA) evidence of aneurysmatic, and stenotic alterations of splanchnic arteries. Based on clinical, laboratory, and radiological features, segmental arterial mediolysis was suspected. These 2 patients were referred to our Interventional Radiology Department and treated with super-selective transcatheter arterial embolization (TAE), performed by a minimally invasive approach, allowing an immediate clinical improvement with regression of symptoms and avoiding major surgical treatment. Conclusions: In patients with clinical, laboratory, and radiological signs of acute and/or chronic abdominal bleeding and radiological findings suggesting segmental arterial mediolysis, mini-invasive endovascular treatment is a safe, extremely reliable, and secure procedure and appears to be the first-choice treatment when available. Since abdominal bleeding could have fatal consequences in these patients, timely diagnosis and endovascular therapy are essential to treat visceral vascular alterations due to segmental arterial mediolysis.

An Unusual Presentation of Segmental Arterial Mediolysis

“… 3 It can often lead to detrimental complications such as dissection, aneurysm, stenosis, and vessel rupture. 3 , 4 …”

“…3 It can often lead to detrimental complications such as dissection, aneurysm, stenosis, and vessel rupture. 3,4 Although SAM from a pathophysiological nature is noninflammatory, the clinical presentation can mimic vasculitis. 1 Inflammatory markers are not elevated in SAM.…”

Hepatic segmental arterial mediolysis: A case report and brief literature review

“…It usually involves medium and large sized abdominal splanchnic vessels, such as the celiac, mesenteric, and/or renal arteries with occasional carotid, cerebral, and coronary artery involvement 2 . The usual presentation is a middle‐aged or elderly patient with abdominal and/or flank pain but could also present with catastrophic hypovolemia or hemorrhagic shock in severe forms 4 . Although histology is still considered the standard method for confirming a diagnosis of SAM, the growing quality of non‐invasive imaging techniques such as CT and MR angiograms has led to an increase in the use of these imaging modalities over tissue biopsy 2,3 .…”

“… 2 The usual presentation is a middle‐aged or elderly patient with abdominal and/or flank pain but could also present with catastrophic hypovolemia or hemorrhagic shock in severe forms. 4 Although histology is still considered the standard method for confirming a diagnosis of SAM, the growing quality of non‐invasive imaging techniques such as CT and MR angiograms has led to an increase in the use of these imaging modalities over tissue biopsy. 2 , 3 This shift is due to current discrepancies regarding anatomic involvement and the use of inflammatory markers, autoimmune serologies, and genetic testing necessary to diagnose SAM.…”