Role of imaging in visceral vascular emergencies

Abstract

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.

Abdominal Pain Caused by Occlusion of the Celiac Trunk and Superior Mesenteric Artery in Addition to Irritable Bowel Syndrome: Case Series and Literature Review

“…Diagnosis is challenging, and delays in diagnosis carry high mortality. Etiologic factors include atherosclerosis, thrombophilia such as thrombocytosis, protein S, protein C, antithrombin III deficiency, and malignancies [ 7 ]. Patients mostly present with nonspecific abdominal pain, which makes it difficult to differentiate it from benign conditions especially in hemodynamically stable patients.…”

Thrombophilia Impact on Treatment Decisions, Subsequent Venous or Arterial Thrombosis and Pregnancy-Related Morbidity: A Retrospective Single-Center Cohort Study

“…A critical limb ischemia of a peripheral artery disease was established by arterial Doppler ultrasound, CT angiography, MR angiography or catheter-based arteriography [ 29 ]. Renal artery or vein thrombosis, splanchnic vein thrombosis, cerebral vein thrombosis and thrombosis of aorta and vena cava were defined as filling defects in the corresponding vessel on CT or MR angiography or venography [ 30 , 31 , 32 ]. Other types of thromboembolism, such as retinal vein or artery thrombosis, penis vein thrombosis, osteonecrosis or chronic inflammatory disease, along with pregnancy-related morbidity, were defined by relevant specialists using a referral report.…”

Clinical anatomy of hepatic vessels by computed tomography angiography: A minireview

“…In approximately 75% of the cases, a hematologic abnormality or an underlying thrombotic diathesis can be identified[ 30 , 31 ]. CT clearly shows the obstructed hepatic veins and associating parenchymal changes[ 32 ]. The absence of contrast enhancement in the hepatic vein is the pathognomonic imaging findings on CT[ 12 ].…”