Gastrointestinal angiodysplasia

Last revised by Daniel J Bell ◉ on 26 May 2022

Citation, DOI, disclosures and article data

Citation:

Knipe H, Bell D, Kusel K, et al. Gastrointestinal angiodysplasia. Reference article, Radiopaedia.org (Accessed on 27 Mar 2023) https://doi.org/10.53347/rID-40751

DOI:

https://doi.org/10.53347/rID-40751

Permalink:

https://radiopaedia.org/articles/40751

rID:

40751

Article created:

2 Nov 2015, Henry Knipe ◉ ◈

Disclosures:

At the time the article was created Henry Knipe had no recorded disclosures.

View Henry Knipe's current disclosures

Last revised:

26 May 2022, Daniel J Bell ◉

Disclosures:

At the time the article was last revised Daniel J Bell had no financial relationships to ineligible companies to disclose.

View Daniel J Bell's current disclosures

Revisions:

14 times, by 8 contributors - see full revision history and disclosures

Systems:

Gastrointestinal

Tags:

cases

Synonyms:

Gastrointestinal angiodysplastic lesions (GIADs)
Gastrointestinal angioectasias
Angiodysplasia of gastrointestinal tract

Gastrointestinal angiodysplasias (a.k.a. angioectasias) are one of the most common causes of occult gastrointestinal bleeding.

Angiodysplasia refers to dilated, thin-walled blood vessels (capillaries, venules, veins) found in the mucosa and submucosa of the gastrointestinal tract. The pathogenesis is unclear ³. They are multiple in ~50% of cases ^1,2, and can be found throughout the gastrointestinal tract, but most commonly on the antimesenteric border of the cecum and right colon.

Radiographic features

CT

CT angiography (CTA) of the abdomen can diagnose angiodysplasias with a sensitivity of 70%, a specificity of 100%, and a positive predictive value of 100% ⁷. This is especially useful in cases of inconclusive colonoscopic evaluation due to intraluminal blood obscuring small lesions ⁸.

Findings include:

focal areas (<5 mm) of contrast enhancement in the bowel wall (most prominent in the enteric phase ³)
enlargement of the feeding mesenteric artery (e.g. ileocecal artery in cecal angiodysplasia ⁸)
early filling and/or dilatation of the draining mesenteric vein (e.g. ileocecal vein in cecal angiodysplasia ^7,8)

Simultaneous enhancement of the parallel feeding artery and draining vein has been described as a tram-track appearance ⁴.

The use of maximum intensity projections (MIPs) can facilitate visualization of abnormal mural vessels which can be a subtle finding and hard to see on regular axial slices ^7,8.

Angiography

ectatic vessels but no discrete lesion ⁶
early venous enhancement indicating arteriovenous shunting

Treatment and prognosis

Approximately 50% of gastrointestinal hemorrhage from angiodysplasia ceases without intervention. Endovascular treatment is generally not effective and first-line treatment is interventional endoscopy. There is a post-treatment bleeding rate of ~25% ^2,4.