High-Value Multidetector CT Angiography of the Superior Mesenteric Artery: What Emergency Medicine Physicians and Interventional Radiologists Need to Know

Ghodasara, Nevil; Liddell, Robert P.; Fishman, Elliot K.; Johnson, Pamela T.

doi:10.1148/rg.2019180131

Cited by 29 publications

(22 citation statements)

References 64 publications

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“…Therefore, CTA is currently the most sensitive and reliable method for diagnosing SISMAD. At our different hospitals, CTA is the diagnostic test of choice for patients suspected to have SISMAD, while CECT is the most commonly used test when SISMAD is diagnosed incidentally in China (5,6,17). However, in clinical practice, numerous patients cannot directly undergo CTA and rather undergo plain CT first.…”

Section: Discussionmentioning

confidence: 99%

“…SMA dissection was first described by Bauersfeld (2)(3)(4) in 1947 and may be categorized into: i) spontaneous isolated SMA dissection (SISMAD) and ii) SMA dissection combined with aortic dissection. The latter type is more common and is caused by the extension of an aortic dissection flap into the SMA (5). By contrast, SISMAD is a rare but potentially fatal condition.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…Vascular surgeons depend on radiologists to identify and characterize SMA abnormalities and prioritize findings that guide the appropriate triage of patients. 13 During this process, if any participator has insufficient knowledge of IMAD, there is a high risk of misdiagnosis. Therefore, raising awareness of IMAD among participants, especially emergency physicians, is critical to avoid misdiagnosis.…”

Section: Discussionmentioning

confidence: 99%

Accurate diagnosis and treatment of isolated mesenteric artery dissections

Chen

Gao

et al. 2019

Vascular

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Objectives Diagnosis and treatment of isolated mesenteric artery dissections (IMAD) are overlooked. The purpose of this study was to assess the clinical feature, possible diagnostic errors and treatment methods. Methods From January 2010 to December 2017, 99 consecutive patients who were diagnosed with IMAD on computed tomography angiography were enrolled retrospectively. Thirty-nine misdiagnosed patients, false negative, and 60 accurate diagnosis patients with revealed IMAD were compared. In addition, therapeutic schemes were evaluated. Results Ninety-nine patients participated in this study; 39 patients (34 men, 5 women; median age, 51.41 years, range 38–64 years) were included in group A who were misdiagnosed initial visit; the remaining 60 patients (52 men, 8 women; median age, 52.07 years, range 38–68 years) with IMAD who were diagnosed accurately initial visit were included in group B. Significant differences were observed between the two groups with respect to dissection length (55.26 ± 3.88 mm vs. 43.37 ± 2.75 mm; p = 0.01), and branch involvement (14 and 9, respectively; p = 0.04). Ultimately, 33 patients (group A 14 patients and group B 19 patients) underwent invasive interventional therapy, and 66 patients with conservative treatment with antithrombotic agents (group A 25 patients and group B 41 patients). A total of 86 (86.87%) had follow-up computed tomography angiography with a median duration of 24.51 months (range 2–71 months). Three patients died during follow-up. The remaining patients recovered smoothly. Conclusion Physicians should raise the awareness of IMAD and use the optimal treatment time frame. Diagnosis of IMAD depends on imaging examinations, especially computed tomography angiography. Additionally, conservative management is the most common initial treatment. For patients in whom conservative treatment fails, endovascular and/or surgery may be necessary.

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“…The flap within the vessel wall may narrow or completely occlude the vessel lumen and may cause mesenteric ischemia. SMA dissections may be clinically silent; however, emergent presentation with acute abdominal pain, nausea, vomiting, and bloody stools may also be seen [ 65 ]. The false lumen may appear as thrombosed with low attenuation and the false lumen mostly lies along the greater curvature of the SMA, and the true lumen is along the lesser curvature [ 66 ].…”

Section: Superior Mesenteric Arterymentioning

confidence: 99%

Role of imaging in visceral vascular emergencies

et al. 2020

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Differential diagnosis in non-traumatic acute abdomen is broad and unrelated diseases may simulate each other from a clinical perspective. Despite the fact that they are not as common, acute abdominal pain due to diseases related to visceral vessels may be life-threating if not detected and treated promptly. Thrombosis, dissection, and aneurysm in the abdominal visceral arteries or thrombosis in visceral veins may cause acute abdominal pain. Imaging with appropriate protocoling plays a fundamental role in both early diagnosis and determination of the treatment approach in these cases where early treatment can be life-saving. Computed tomography (CT) appears to be the most effective modality for the diagnosis as it provides high detail images in a very short time. Patient cooperation is also a less concern as compared to magnetic resonance imaging (MRI). As the imaging findings may sometimes be really subtle, diagnosis may be difficult especially to inexperienced imagers. Correct protocoling is also very critical to detect arterial abnormalities as visceral arterial abnormalities may not be detectable in portal phase only abdominal CT scans. In this article, we aimed to increase awareness among imaging specialists to these not very common causes of acute abdomen.

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High-Value Multidetector CT Angiography of the Superior Mesenteric Artery: What Emergency Medicine Physicians and Interventional Radiologists Need to Know

Cited by 29 publications

References 64 publications

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

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

Accurate diagnosis and treatment of isolated mesenteric artery dissections

Role of imaging in visceral vascular emergencies

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