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Zhang Y, Zhou JY, Liu J, Bai C. Diagnosis of spontaneous isolated superior mesenteric artery dissection with ultrasound: A case report. World J Clin Cases 2022; 10:5717-5722. [PMID: 35979106 PMCID: PMC9258376 DOI: 10.12998/wjcc.v10.i17.5717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/16/2022] [Accepted: 04/15/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Spontaneous isolated superior mesenteric artery dissection (SISMAD) is a rare disease that originates from the superior mesenteric artery, without the presence of aortic and other arterial dissections. Most cases are diagnosed using contrast-enhanced computed tomography (CECT), whereas the application of ultrasound is less common.
CASE SUMMARY Here, we report a case of SISMAD with sudden epigastric pain that worsened as the main symptom after eating. The patient had a long history of hypertension with unknown blood pressure control but no history of smoking or alcohol consumption. This case was initially diagnosed using ultrasound and the results were later confirmed by CECT. After admission, the patient fasted, followed by parenteral nutrition support and fluid supplementation to maintain electrolyte and acid–base balance. Metoprolol succinate sustained-release tablets and aspirin were given as nonoperative treatments. After 1 wk, the symptoms improved, and the patient was discharged. During telephone follow-up, the patient did not develop similar symptoms.
CONCLUSION Whether ultrasound can be used as a routine and noninvasive imaging method for the diagnosis of SISMAD needs further exploration.
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Affiliation(s)
- Yi Zhang
- Department of Ultrasound, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610599, Sichuan Province, China
| | - Jiang-Ying Zhou
- Department of Ultrasound, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610599, Sichuan Province, China
| | - Jian Liu
- Department of Ultrasound, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610599, Sichuan Province, China
| | - Chen Bai
- Department of Radiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610599, Sichuan Province, China
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Evola G, Reina GA, Cavallaro D, Foti PV, Musumeci AG, Palmucci S, Basile A. Two Cases of Spontaneous Isolated Dissection of Superior Mesenteric Artery in One Night: Report of a (Noninvasive) Double Challenge. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e929538. [PMID: 33848284 PMCID: PMC8053640 DOI: 10.12659/ajcr.929538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Spontaneous isolated dissection of the superior mesenteric artery (SID-SMA) is a rare but potentially fatal condition. Although many cases of SID-SMA have been reported in the literature in recent years because of the increased use of contrast-enhanced computed tomography (CT) scanning, optimal management has not yet been firmly established. CASE REPORT We report 2 cases of SID-SMA that were managed with stenting and angioplasty via transfemoral access. In case 1 a 54-year-old man presented with diffuse abdominal pain without Blumberg sign. Laboratory data were unremarkable. Abdominal CT scanning revealed SID-SMA and initial bowel ischemia. The angiogram revealed a dissected true lumen of SMA with a narrowing of the ileo-colic artery managed, respectively, with self-expandable stent placement and angioplasty. In case 2, a 45-year-old man presented with severe abdominal cramping and pain of 3 days' duration. Physical examination revealed abdominal tenderness with positive Blumberg sign. Laboratory tests showed leukocytosis and increased lactate dehydrogenase. Abdominal CT scan revealed SID-SMA and initial bowel ischemia. After an SMA angiogram, 2 self-expandable stents were placed and an angioplasty was performed. Although a postprocedural angiogram showed good patency of the SMA in both patients, the first patient had a recurrence of abdominal pain after 5 days with a new narrowing tract of the SMA and more inferiorly a dissection with aneurysm of a false lumen, detected on CT scan, treated respectively with stenting and coils. CT follow-up showed successful morphological results in both patients. CONCLUSIONS In our experience, endovascular treatment of SID-SMA is safe and effective, including in cases of recurrence and postprocedural evolution.
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Affiliation(s)
- Giuseppe Evola
- Department of General and Emergency Surgery, Garibaldi-Nesima Hospital, Catania, Italy
| | | | - Dario Cavallaro
- Department of General Surgery, Santa Marta e Santa Venera Hospital, Acireale, Italy
| | - Pietro Valerio Foti
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia" - Radiology Unit I, University Hospital "Policlinico-San Marco", Catania, Italy
| | - Andrea Giovanni Musumeci
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia" - Radiology Unit I, Valerio, Catania, Italy
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia" - Radiology Unit I, University Hospital "Policlinico-San Marco", Catania, Italy
| | - Antonio Basile
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia" - Radiology Unit I, University Hospital "Policlinico-San Marco", Catania, Italy
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Tan Z, Jin Q, Fan W, Han P, Li X. Clinical implications of perivascular fat stranding surrounding spontaneous isolated superior mesenteric artery dissection on computed tomography. Exp Ther Med 2021; 21:34. [PMID: 33262820 PMCID: PMC7690343 DOI: 10.3892/etm.2020.9466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 10/09/2020] [Indexed: 12/28/2022] Open
Abstract
Patients with spontaneous isolated superior mesenteric artery (SMA) dissection (SISMAD) usually present with acute or chronic abdominal pain and are admitted to the emergency or digestive diseases department to undergo auxiliary examinations, typically abdominal plain CT or contrast-enhanced CT (CECT). Plain CT is the most crucial examination in emergency radiology. An enlarged SMA diameter and perivascular fat stranding (PFS) on plain CT, though non-specific, may be the only indications for SISMAD. These results may be easily overlooked and the diagnosis of SISMAD may be missed. However, PFS around the SMA on CT may be the only indicator of the possible presence of SISMAD, particularly during the early stage when there are no massive changes in the vascular wall. The present study aimed to determine whether PFS surrounding the SMA on CT may help with the diagnosis of SISMAD by indicating the requirement for further examination. The data of 161 consecutive patients with SMA dissection who underwent abdominal CECT or underwent SMA CT angiography (CTA) after abdominal plain CT between February 2015 and February 2018 were retrospectively reviewed. SMA diameter, classification, PFS, complications, comorbidities and treatments were analyzed. The results demonstrated that SISMAD with PFS was significantly associated with admission type (emergency), clinical manifestations (abdominal pain), diagnostic modality and dissection subtype. On plain CT, PFS surrounding the SMA may be a marker for SISMAD, particularly in the emergency setting, and indicates the requirement for CTA examination.
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Affiliation(s)
- Zhengwu Tan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, Hubei 430022, P.R. China
| | - Qianna Jin
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, Hubei 430022, P.R. China
| | - Wenliang Fan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, Hubei 430022, P.R. China
| | - Ping Han
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, Hubei 430022, P.R. China
| | - Xin Li
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, Hubei 430022, P.R. China
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Ramirez LM, Casillas S, Berjaoui H, Varon J, Surani S. Superior Mesenteric Artery Dissection After Lumbar Puncture. Cureus 2020; 12:e7507. [PMID: 32373410 PMCID: PMC7195201 DOI: 10.7759/cureus.7507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
We hereby present a case of iatrogenic dissection of the superior mesenteric artery dissection in a 63-year-old female undergoing a lumbar puncture (LP). She presented with severe diffused abdominal pain accompanied by lower back pain, nausea and vomiting a few hours after undergoing an LP due to ongoing headaches. Abdominal CT showed evidence of hemoperitoneum. She was then transferred to another facility and while in route received one unit of packed red blood cellsdue to drop in hemoglobin levels from 15 to 11 gm/dl. Physicians should consider the possibility of arterial variations and the level at which spinal tap is performed during interventions. Acute abdominal pain is a significant, common complaint that should be appropriately investigated.
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Affiliation(s)
- Luz M Ramirez
- Pulmonology and Critical Care, Benemerita Universidad Autonoma De Puebla, Puebla, MEX
| | | | - Hussein Berjaoui
- Medicine, Dorrington Medical Associates, Houston, USA.,Medicine, Beirut Arab University, Beirut, LBN
| | - Joseph Varon
- Critical Care, United General Hospital, Houston, USA.,Critical Care, University of Texas Health Science Center, Houston, USA
| | - Salim Surani
- Internal Medicine, Texas A&M Health Science Center, Bryan, USA.,Internal Medicine, Corpus Christi Medical Center, Corpus Christi, USA.,Internal Medicine, University of North Texas, Dallas, USA
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Santos RFT, Camilo DMR, Domingos TA, Nunes TF, Marchiori E. Spontaneous dissection of the left gastric artery: a rare cause of abdominal pain. Radiol Bras 2019; 52:204-206. [PMID: 31210701 PMCID: PMC6561361 DOI: 10.1590/0100-3984.2017.0199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Ullah W, Mukhtar M, Abdullah HM, Ur Rashid M, Ahmad A, Hurairah A, Sarwar U, Figueredo VM. Diagnosis and Management of Isolated Superior Mesenteric Artery Dissection: A Systematic Review and Meta-Analysis. Korean Circ J 2019; 49:400-418. [PMID: 31074212 PMCID: PMC6511528 DOI: 10.4070/kcj.2018.0429] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/11/2019] [Accepted: 03/13/2019] [Indexed: 12/17/2022] Open
Abstract
The objective of this study was to analyze the three different management modalities for isolated superior mesenteric artery (SMA) dissection. We did a comprehensive literature search and found 703 articles on the initial search, out of which 111 articles consisting of 145 patients were selected for analysis. The mean age was 55.7 years (standard deviation,9.7;33-85) and 80.6% were male. These patients were managed conservatively (41.3%), endovascularly (28.1%) or surgically (30%). The median follow-up was 10 months (interquartile range [IQR], 4-18 months), 12 months (IQR, 6-19 months) and 14 months (IQR, 6-20 months) respectively. Contrast-enhanced computed tomography (CT) was the most commonly used diagnostic tool in the conservative group (43.8%), while conventional CT scan was the most widely used in endovascular (58.1%) and surgical group (50%). 17% percent of the conservative group had SMA angiography for diagnosis, while this was less than 3% in the other groups. Of these patients, 96.7%, 97.4%, and 100.0% recovered successfully in the conservative, endovascular, and surgical groups respectively. There was no significant difference in the mortality between the three groups (Pearson χ²=0.482). This suggests a conservative and endovascular approach could be used in most patients, which can reduce costs and surgery-related morbidity and mortality. Surgical management should be reserved for cases having infarction or widespread bowel ischemia and in cases where other treatment modalities fail.
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Affiliation(s)
- Waqas Ullah
- Department of Internal Medicine, Abington Hospital - Jefferson Health, Abington, PA, USA.
| | - Maryam Mukhtar
- Department of Internal Medicine, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Hafez Mohammad Abdullah
- Department of Internal Medicine, University of South Dakota Sanford School of Medicine, SD, USA
| | - Mamoon Ur Rashid
- Department of Internal Medicine, Florida Hospital Orlando, Orlando, FL, USA
| | - Asrar Ahmad
- Department of Internal Medicine, Abington Hospital - Jefferson Health, Abington, PA, USA
| | - Abu Hurairah
- Department of Gastroenterology, Advent Health Orlando, FL, USA
| | - Usman Sarwar
- Department of Internal Medicine, Abington Hospital - Jefferson Health, Abington, PA, USA
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Rodney SR, Vivekanand, Vishnu M, Raj S, Chaudhari H, S Sravan CP, Lende V, Vishal H, Krishna KS, Nishan B. Endovascular stenting of spontaneous isolated dissection of superior mesenteric artery. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2019. [DOI: 10.4103/ijves.ijves_91_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Salt Ö, Sayhan MB, Duyar E. Isolated superior mesenteric artery dissection in the emergency department: A rare cause of abdominal pain. Am J Emerg Med 2018; 36:2341.e1-2341.e2. [DOI: 10.1016/j.ajem.2018.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/04/2018] [Accepted: 09/18/2018] [Indexed: 10/28/2022] Open
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Gao DN, Qi QH, Gong P. Endovascular stenting of spontaneous isolated dissection of the superior mesenteric artery: A case report and literature review. Medicine (Baltimore) 2017; 96:e8598. [PMID: 29145276 PMCID: PMC5704821 DOI: 10.1097/md.0000000000008598] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
RATIONALE Spontaneous isolated dissection of the superior mesenteric artery (SID-SMA) is a rare arterial disease that is difficult to differentiate from other diseases because of lack of specific clinical manifestation and for which there is no available optimal management strategy. PATIENT CONCERNS A 58-year-old male patient visited our emergency room with sudden onset of moderate-severe epigastric abdominal pain of uncertain cause. DIAGNOSES Computed tomography scanning showed a characteristic "double lumen sign" of the superior mesenteric artery, and further computed tomography angiography findings revealed a dissected segment of the superior mesenteric artery. INTERVENTIONS Conservative management was administered for 5 days, but the abdominal pain remained. Subsequently, an endovascular stent was placed in the affected superior mesenteric artery. Postoperative antiplatelet therapy was administered for 6 months. OUTCOMES The abdominal pain was relieved. Six months later, a follow-up of computed tomography angiography showed that the stent placed had no interval narrowing. LESSONS Based on our review and the illustration of this case, endovascular stenting may be a preferred rescue treatment in SID-SMA patients for whom initial conservative treatment fails.
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Affiliation(s)
| | - Qing-Hui Qi
- Department of Abdominal Emergency, the First Affiliated Hospital of Dalian Medical University, Dalian, China
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