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Bowel ischemia, mesenteric arterial vascular occlusion

Case contributed by Kareem Mohamed
Diagnosis almost certain

Presentation

Acute abdominal pain.

Patient Data

Age: 50 years
Gender: Male

Right lumbar quadrant few dilated small bowel loops showing a relatively hypoenhancing wall and notable fecalization of bowel content.

Axial and sagittal arterial phase images show attenuation of the distal superior mesenteric artery branches with small filling defects.

Small splenic and right renal wedge-shaped hypodensities suggestive of infarctions.

Lower chest cuts show a left ventricular intraluminal hypodense filling defect representing a thrombus.

Case Discussion

This case has three important categories of findings in bowel ischemia. The small bowel indirect signs are the dilated small bowel loops which represent disruption of peristaltic activity, yet the hypoenhancing wall relative to the collapsed bowel is more specific.

The second important finding is detected by tracing the mesenteric vessels and identifying the occluded segments which is important for intervention.

The third and additional finding of the source of embolization is the presence of cardiac thrombus which in this case happened to be in the left ventricle, likely secondary to previous myocardial infarction.

Additional subtle findings of a small splenic and right renal wedge shaped infarctions are also helpful clues.

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