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Morimura F, Edo H, Niwa T, Sugiura H, Suyama Y, Okazaki S, Narimatsu K, Ohno H, Okamoto K, Ueno H, Yoshimatsu S, Miyai K, Hamamoto K, Shinmoto H. Idiopathic myointimal hyperplasia of mesenteric veins: radiological evaluation using CT angiography. BJR Case Rep 2024; 10:uaad009. [PMID: 38352257 PMCID: PMC10860510 DOI: 10.1093/bjrcr/uaad009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 02/16/2024] Open
Abstract
A 44-year-old man presented with a chief complaint of constipation. Initial contrast-enhanced CT showed extensive bowel wall thickening, mainly in the left colon, with a thin cord-like inferior mesenteric vein (IMV), in contrast to ectatic mesenteric venous branches, suggesting bowel ischaemia owing to venous stasis. One month later, at the time of symptom exacerbation, CT angiography showed a cord-like IMV and ectatic mesenteric venous branches with early enhancement, suggesting the presence of an arteriovenous fistula (AVF). Owing to the progression of bowel ischaemia and necrosis with peritonitis, emergency surgery was performed. Surgical specimens showed focal myointimal hyperplasia of the proximal mesenteric veins in both ischaemic and non-ischaemic lesions of the resected colon, thus leading to the diagnosis of idiopathic myointimal hyperplasia of mesenteric veins (IMHMV) when combined with the clinical and imaging findings. IMHMV is a bowel ischaemic disease caused by non-thrombotic venous obstruction that requires bowel resection and has been suggested to be associated with AVF. Cord-like IMV and AVF in the mesentery are important CT findings that characterize IMHMV. CT angiography is useful in diagnosing IMHMV.
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Affiliation(s)
- Fumio Morimura
- Department of Radiology, National Defense Medical College, Saitama 3598513, Japan
| | - Hiromi Edo
- Department of Radiology, National Defense Medical College, Saitama 3598513, Japan
| | - Takafumi Niwa
- Department of Radiology, National Defense Medical College, Saitama 3598513, Japan
| | - Hiroaki Sugiura
- Department of Radiology, National Defense Medical College, Saitama 3598513, Japan
| | - Yohsuke Suyama
- Department of Radiology, National Defense Medical College, Saitama 3598513, Japan
| | - Soya Okazaki
- Department of Internal Medicine, National Defense Medical College, Saitama 3598513, Japan
| | - Kazuyuki Narimatsu
- Department of Internal Medicine, National Defense Medical College, Saitama 3598513, Japan
| | - Hiroki Ohno
- Department of Surgery, National Defense Medical College, Saitama 3598513, Japan
| | - Koichi Okamoto
- Department of Surgery, National Defense Medical College, Saitama 3598513, Japan
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College, Saitama 3598513, Japan
| | - Shinya Yoshimatsu
- Department of Basic Pathology, National Defense Medical College, Saitama 3598513, Japan
| | - Kosuke Miyai
- Department of Basic Pathology, National Defense Medical College, Saitama 3598513, Japan
| | - Kohei Hamamoto
- Department of Radiology, Jichi Medical University, Tochigi 3290498, Japan
| | - Hiroshi Shinmoto
- Department of Radiology, National Defense Medical College, Saitama 3598513, Japan
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