Presentation
Severe abdominal pain.
Patient Data
Extensive motion degradation of both phases of the examination. Relative dilation of the right heart. Suspected bilateral pulmonary emboli. Diffuse hypoenhancement of the spleen. Hypoenhancement/infarct of the majority of the right kidney. Embolus filling the SMA from its origin distally. Several loops of relatively dilated small bowel with thin, hypoenhancing walls. Right groin hematoma related to attempted vascular access.
Case Discussion
Teaching case illustrating the challenges surrounding the confident diagnosis of acute SMA embolus and mesenteric ischemia, which in this case are made more difficult by the patient's extensive motion due to being in such severe distress. However, other embolic events in the abdomen/pelvis can help to direct your review appropriately, which include infarct of the entire spleen and much of the right kidney. The clot can be seen in both portal venous and arterial phase with careful review. Small bowel loops with findings of acute ischemia, with relative dilation and relatively thin, hypoenhancing walls. Additionally, the patient is suspected to have acute pulmonary embolus with dilation of the right heart, indicating elevated right heart pressures.
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