Unusual computed tomography findings of gas in the superior mesenteric artery system with no signs of porto-mesenteric venous gas in a case of acute mesenteric ischemia

Could CT finding of gas in the sole mesenteric artery be a sign of a severe acute ischemia? Presentation of a rare fatal case and a literature review

“…Finally, a recent paper reported a case of AMI resulting from acute thrombotic occlusion of SMA with evidence of paralytic ileus, marked parietal thinning of the small bowel, absence of parietal enhancement, and PI. As in our case, the peculiar finding of gas in the mesenteric arterial system but without evidence of involvement of the portal-mesenteric venous system was described [23] .…”

“… [22] 83, F Abdominal pain for two days Findings of sepsis Lack of enhancement in the intestinal and cecal wall, with intramural gas, portal venous gas and gas in the superior mesenteric artery Extensive bowel resection Death 27 days after for progression of the mediastinal tumor Giulio et al. [23] 89 Abdominal pain and vomiting Leucocytosis ↑ Troponin ↑ Lactate Paralytic ileus; marked parietal thinning of the small bowel; absence of parietal enhancement and PI - Death This case 80 Abdominal pain Leucocytosis ↑ PCR ↑ LDH SMA - SMV thrombosis; marked thinning of the small bowel wall, lack of contrast-enhancement without luminal dilatation and air-fluid levels. Surgery Death after 1 day in Intensive Care Unit …”