Detecting isolated superior mesenteric artery dissection with computed tomography

Abstract

Aim: Isolated superior mesenteric artery (SMA) dissection without associated aortic dissection is a rare entity. The aim of the study is to evaluate its incidence, and multidetector computed tomography (MDCT) and computed tomography angiography (CTA) findings, as well as show the clinical importance of this condition, which should be diagnosed and treated urgently. Methods: Images of all patients who underwent contrast enhanced CTA or MDCT scan from July 2017 to July 2020 at our radiology department were examined retrospectively. A total of 600 CTA and 14000 contrast enhanced MDCT scans (14600 CT) were evaluated. Only the cases with isolated SMA dissections without aortic involvement, who had arterial phases on contrast enhanced MDCT images, were included. Aortic dissection cases with SMA involvement, and non-contrast MDCT images were excluded. Age, gender, symptoms, presence of thrombosis or bowel ischemia were noted. Average extension of dissection and distance from origin were measured. Results: Ten patients (7 M, 3 F), aged between 48-66 years (mean: 57 years), had isolated SMA dissection. The mean distance of dissection from origin and mean extension were 1.9 cm and 3.4 cm, respectively. Patients were treated with conservative anticoagulation therapy. Follow-up CTA or MDCT showed normal SMA without evidence of dissection in 5 patients, decreased extension and length of dissection in 3 patients and no significant difference in 2 patients. Conclusion: Isolated SMA dissection is a rare but important cause of abdominal pain. Early diagnosis allows correct treatment. CT is a useful noninvasive method for diagnosis and anticoagulation therapy is successful.

Keywords

• Superior mesenteric artery
• dissection
• computed tomography
• mesenteric ischemia
• isolated

İzole süperior mezenterik arter diseksiyonunun bilgisayarlı tomografi ile tespit edilmesi

Öz

Amaç: Aort diseksiyonu olmaksızın görülen izole süperior mezenterik arter (SMA) diseksiyonu nadir bir durumdur. Çalışmanın amacı, insidansı ve çok dedektörlü bilgisayarlı tomografi (ÇKBT) ve bilgisayarlı tomografi anjiyografi (BTA) bulgularını değerlendirmek ve acilen teşhis ve tedavi edilmesi gereken bu durumun klinik önemini ortaya koymaktır. Yöntemler: Temmuz 2017'den Temmuz 2020'ye kadar radyoloji bölümümüzde kontrastlı BTA veya ÇKBT taraması yapılan tüm hastaların görüntüleri geriye dönük olarak incelendi. 600 BTA ve 14000 kontrastlı ÇKBT taraması değerlendirildi. Sadece, aort tutulumu olmayan izole SMA diseksiyonları dahil edildi. SMA tutulumu olan aort diseksiyonları dahil edilmedi. Arteriyel faza sahip kontrastlı ÇKBT görüntüleri dahil edildi. Yaş, cinsiyet, semptomlar, tromboz veya bağırsak iskemisi varlığı kaydedildi. Ortalama diseksiyon uzunluğu ve orijinden uzaklık ölçüldü. Bulgular: 10 hastada (7 E, 3 K) izole SMA diseksiyonu vardı. Hastaların yaş aralığı 48 ile 66 (ortalama 57) arasındaydı. Diseksiyonun orijinden ortalama uzaklığı 1,9 cm ve ortalama uzunluğu 3,4 cm idi. Hastalar konservatif olarak antikoagülan ile tedavi edildi. Takip BTA veya ÇKBT’de 5 hastada diseksiyonda kaybolma, 3 hastada diseksiyon uzunluğunda azalma izlenirken 2 hastada anlamlı bir fark saptanmadı. Sonuç: İzole SMA diseksiyonu nadir görülen önemli karın ağrısı nedenlerindendir. Erken teşhis doğru ve zamanında tedaviye izin verir. BT tanı için yararlı noninvaziv bir yöntemdir ve antikoagülan tedavi başarılıdır.

Anahtar Kelimeler

• Superior mezenterik arter
• Diseksiyon
• Bilgisayarlı tomografi
• Mezenterik iskemi,
• İzole

Kaynakça

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