Spontaneous Celiac Artery Dissection Presenting With Splenic Infarction: A Case Report

Spontaneous isolated celiac artery dissection (SICAD) is extremely rare. We herein report a case of a 43-year-old male with no known history of cardiovascular disease who presented to the emergency department (ED) with sudden onset severe epigastric abdominal pain without a known trigger. Abdominal computed tomography (CT) scan showed a focal dissection and irregular enhancement of the celiac trunk with associated splenic artery embolus and large splenic infarct. The patient was successfully treated conservatively with blood pressure control, antiplatelet and anticoagulation therapy.

A Case of Successful Treatment of Ruptured Pancreaticoduodenal Artery Aneurysm Caused by Celiac Artery Dissection

A 52-year-old man was admitted due to severe epigastric lesion pain. Esophagus gastroduodenal endoscopy showed impaired duodenal dilatation, and contrast-enhanced computed tomography revealed a pancreaticoduodenal artery (PDA) aneurysm 13 mm in diameter below the head of the pancreas, retroperitoneal hematoma, idiopathic celiac artery (CA) dissection, and common hepatic artery disruption. Angiographic embolization with a mixture of N-butyl-1,2-cyanoacrylate and lipiodol was performed, and follow-up study showed improvement of the dilatation of the duodenum and disappearance of the aneurysm. Here we report a quite rare case of PDA aneurysm by idiopathic dissection of CA treated successfully with angiographic embolization.

A Rare Cause of Acute Abdomen in a 59-Year-Old Male

Celiac artery dissection is often an inconspicuous cause of acute abdomen. Spontaneous celiac artery dissection is most often associated with aortic dissection, and thus isolated spontaneous celiac artery dissection is rare. Herein, we present a case of celiac artery dissection with no aortic involvement. This case emphasizes the importance of including such a condition in the differential diagnosis of patients presenting with acute abdomen.

Spontaneous celiac artery dissection treated by balloon angioplasty

Spontaneous isolated celiac artery dissection (SICAD) is a rare condition, defined as dissection of the celiac artery without aortic involvement. Because of its low prevalence, most studies have been limited to case reports and case series. We have described the case of a 44-year-old woman who had presented with symptomatic SICAD that had resulted in compromised flow to the hepatic arteries and was successfully treated with balloon angioplasty. Angioplasty alone might be effective for cases of extensive false lumen thrombosis in SICAD for immediate flow restoration to the true lumen, expediting positive remodeling.

Diagnosis and treatment of isolated celiac artery dissection following blunt trauma: A case report

Introduction

Celiac artery (CA) dissection due to blunt abdominal trauma is extremely rare and, as such, the clinical features of this potentially life-threatening injury have not been clearly defined, nor have treatment strategies been established.

Presentation of case

We describe the case of a 61-year-old man who presented to our emergency department after a motor vehicle accident. Although the patient did not report abdominal pain, enhanced computed tomography (CT) revealed CA dissection. The patient was treated conservatively using antiplatelet therapy and was discharged from the hospital on day 8, without complications.

Discussion

As abdominal pain is not a common presenting factor of CA dissection after blunt trauma, it should be suspected as a potential injury in all affected patients and comprehensively assessed, with CT being the most useful diagnostic modality.

Conclusion

In the absence of any signs of organ ischemia, changes in the CA aneurysm, and persistent, severe abdominal pain following blunt abdominal trauma, conservative treatment is indicated, with or without anticoagulation or antiplatelet therapy.

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Celiac artery (CA) dissection due to blunt abdominal trauma is extremely rare.

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We describe a case of CA dissection after a motor vehicle accident.

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Enhanced computed tomography revealed the CA dissection.

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The patient was treated conservatively and was discharged from hospital on day 8.

A useful modality of CT angiography image to identify medical emergency in isolated celiac artery dissection type I: A case report with longest follow-up and literature review

Symptomatic isolated celiac artery (CA) dissection (SICAD) is an extremely rare form of visceral artery dissection. It is diagnosed by a contrast abdominal computed tomography (CT) scan showing a CA dissection (CAD). There are 4 types of CAD: Type I-IV. Type I has entry and re-entry and no true luminal narrowing. All types other than type I have entry and re-entry. They have true lumen compression and true lumen constriction due to false lumen. We report a case with the longest follow-up, 120 months after symptom onset, without evidence of CAD exacerbation. A 56-year-old man presented with a sudden onset of abdominal and back pain. He had a past medical history of left pneumothorax, pulmonary tuberculosis at the age of 23, and hypertension on medication since the age of 46. On physical examination, he had mild muscle rebound tenderness in the epigastric region. The curved multiplanar reconstruction (MPR) of the urgent 3-dimensional contrast-enhanced abdominal computed tomography angiography (CTA) showed an isolated celiac artery dissection type I. Given the risk of emergency surgery for total occlusion of the CA, conservative management with analgesics during hospitalization resolved the abdominal pain, and the patient was discharged 3 days later. Subsequently, a total of 5 CTAs were performed over 120 months, but no worsening of CA arterial dissection and CA occlusion findings were observed. In type I SICAD cases, arterial dissection, and CA occlusion may progress, in which case emergency stenting or endovascular treatment may be indicated, and close follow-up such as CTA is required.

Splenic artery aneurysm masquerading as upper gastrointestinal bleeding: A rare case report

INTRODUCTION AND IMPORTANCE

Splenic artery aneurysm is extremely rare but potentially life threatening disease which poses great challenge in diagnosing due to non-specific nature of clinical presentation. Rarely, it presents with upper gastrointestinal bleeding i.e. hematemesis and melena.

CASE PRESENTATION

A 58-years-old male presented with three and half month history of black tarry stool and abdominal pain, who was initially diagnosed as erosive gastritis and managed with antacids and PPI. After few months of resolution of symptoms, he experienced light-headedness, severe epigastric pain and syncopal episodes. That led to further imaging study which revealed splenic artery aneurysm with celiac artery dissection for which he underwent splenectomy after failure two repeat embolization intervention. Postoperative recovery was smooth, and he remained asymptomatic on follow-up.

CLINICAL DISCUSSION

Though, there is constant risk of SAA to rupture, in our case pressure exerted by aneurysm on celiac artery caused dissection and upper GI bleeding. Endovascular technique is preferred technique but surgery reserved as options in case of failure.

CONCLUSION

This case highlights the complexities in diagnosing and treating life threating splenic artery aneurysm with celiac artery dissection.

Multi-modal imaging for the diagnosis of spontaneous visceral artery dissection: A case report

BACKGROUND

Spontaneous visceral artery dissection (SVAD) is a rare condition that affects the visceral arteries, such as the celiac, superior mesenteric, and inferior mesenteric arteries, without involving the aorta. Organ ischemia or hemorrhage from vessel rupture can occur in SVAD; therefore, prompt detection and management is essential. Contrast-enhanced computed tomography (CECT) has been used to diagnose most of the previous cases, but few studies have explored the potential of contrast-enhanced ultrasound (CEUS) for early detection of this disease.

CASE SUMMARY

A 53-year-old male presented with complaints of poor appetite and abnormal liver function for the past 6 months. He had previously undergone transabdominal splenectomy, esophagogastric devascularization, and cholecystectomy for gallstones and severe portal hypertension. Liver ultrasound was performed in our department to assess liver status. An abnormal hepatic artery spectrum was observed, and dissection involving both the celiac artery and the common hepatic artery was observed. A CEUS was then performed and clearly showed the entry site of the intimal tear and the false lumen, and dissection was subsequently confirmed by CECT. The patient was asymptomatic; therefore, treatment to control the blood pressure was provided, and follow-up was recommended. After 6 months of follow-up, the celiac artery was found to be dilated with an adherent thrombus visible in the wall, and the common hepatic artery was occluded with the presence of collateralization. Despite these findings, no significant changes in liver function were observed.

CONCLUSION

Multi-modal imaging is effective in diagnosing SVAD, and conservative treatment is a choice for asymptomatic patients.

Imaging characteristics and clinical outcomes of spontaneous celiac artery dissection

PURPOSE

Spontaneous celiac artery dissection (CeAD) is a rare cause of acute abdominal pain. This study examined computed tomography (CT) scan findings, natural course, and outcomes of spontaneous CeAD.

METHODS

Sixty patients who underwent CT scan and were diagnosed with CeAD between April 2003 and June 2023 were retrospectively reviewed. Patients with aortic dissection (n = 25), iatrogenic CeAD (n = 6), traumatic CeAD (n = 1), and celiac artery (CeA) aneurysm (n = 4) and those undergoing noncontrast-enhanced CT scans (n = 1) were excluded. The remaining 23 consecutive patients were divided into the acute symptomatic and chronic asymptomatic CeAD groups. Correlations between CT classification, treatment, and outcomes were investigated.

RESULTS

Eighteen (78.2%) patients had hypertension requiring treatment. Of 23 patients, 18 were asymptomatic, and five had CeAD-related abdominal pain requiring hospitalization. Two had intraperitoneal bleeding. All hospitalized patients initially received conservative treatment. Upon the initial diagnosis, the mean CeA maximum outer diameter was 11.0 mm (range: 7-16). Ten (43.5%) patients had stenosis at the CeA origin. Based on CT findings from initial diagnosis to final follow-up, the outer diameter remained stable. CT showed that chronic CeAD was mostly Kim classification type IA or IB. In symptomatic patients, the dissection length on initial CT significantly decreased by final CT. No follow-up symptoms were related to CeAD, and the condition remained stable. No patients required vascular repair or surgery, and there were no deaths.

CONCLUSION

Spontaneous CeAD, asymptomatic and symptomatic, remained stable in imaging and clinical outcomes with conservative treatment. The Kim classification on CT plays a key role in identifying chronic CeAD, mostly type IA or IB.