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Isolated spontaneous dissection of a visceral artery: a rare cause of epigastric pain

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Abstract

Background

Isolated spontaneous dissection of the celiac trunk or superior mesenteric artery is rarely considered in patients with acute abdominal pain. However, with advances in computed tomography (CT) technology, more cases are being detected.

Purpose

The aim of this study was to describe the clinical manifestation and the classical CT features of isolated spontaneous celiac trunk and superior mesenteric artery (SMA) dissection.

Material and methods

The records of seven patients were reviewed to assess demographic data, presenting symptoms, location of dissection, diagnostic modalities, imaging findings, complications, and treatment.

Results

Six patients were men. The average age was 57 years (range, 44–80). Six had epigastric pain and one was asymptomatic. All were diagnosed by CT. The location of dissection was the celiac trunk in three and SMA in four. In all cases, the diagnosis was made by identifying an intimal flap on contrast-enhanced CT images. Extension of dissection to the hepatic artery was found in three patients. A number of associated imaging findings were also present: infiltration of the fat surrounding the vessel (four cases), aneurysmal dilatation (six), thrombosed false lumen (four), significant stenosis (two), and additional aortic or visceral artery aneurysm (four). One patient had renal infarction 2 weeks after initial presentation. Extensive evaluation of all patients revealed no serologic evidence to support the presence of vasculitis or an inflammatory disorder. All were treated conservatively with antihypertensive drugs, anti-inflammatory drugs, steroids, and anticoagulants.

Conclusion

Isolated spontaneous splanchnic artery dissection should be considered in the differential diagnosis of acute abdominal pain.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Radiology, Hillel Yaffe Medical Center, P.O.B. 169, 38100, Hadera, Israel

    Abdel-Rauf Zeina, Alicia Nachtigal, Uri Soimu & Michael Oster

  2. Division of Surgery, Hillel Yaffe Medical Center, Hadera, Israel

    Ahmad Mahamid & Itamar Ashkenazi

  3. Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel

    Abdel-Rauf Zeina, Alicia Nachtigal, Ahmad Mahamid, Uri Soimu, Itamar Ashkenazi & Michael Oster

Authors
  1. Abdel-Rauf Zeina
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  2. Alicia Nachtigal
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  3. Ahmad Mahamid
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  4. Uri Soimu
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  5. Itamar Ashkenazi
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  6. Michael Oster
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Correspondence to Abdel-Rauf Zeina.

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Zeina, AR., Nachtigal, A., Mahamid, A. et al. Isolated spontaneous dissection of a visceral artery: a rare cause of epigastric pain. Emerg Radiol 22, 215–220 (2015). https://doi.org/10.1007/s10140-014-1255-8

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  • DOI: https://doi.org/10.1007/s10140-014-1255-8

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