Presentation
Diagnosed with valvular heart disease and coronary artery disease. Pulsatile abdominal mass for which an abdominal aortic aneurysm was suspected.
Patient Data
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The aorta and its branches are atherosclerotic.
There is stenosis at the proximal abdominal aorta with occlusion of the celiac and superior mesenteric arteries.
Inferior mesenteric artery aneurysm, measuring 3.0 cm in maximum diameter, is demonstrated.
Supply to the branches of the celiac and SMA is provided by the inferior mesenteric artery through the dilated central anastomotic mesenteric artery (arc of Riolan) and small marginal artery of Drummond, pancreaticoduodenal arcade and inferior phrenic artery. The left gastric artery and rectal arteries are dilated probably participating in collateral formation.
Left renal artery stenosis is also seen.
Other findings:
- cardiomegaly with minimal pericardial effusion
- hepatic calcifications
- smaller than usual right kidney
- renal cortical scarring, bilateral
- minimal pelvic fluid
- degenerative osseous changes
Case Discussion
This is a case of inferior mesenteric artery (IMA) aneurysm with occlusive disease of the celiac and superior mesenteric arteries. IMA aneurysms are rare. They are usually asymptomatic and are commonly discovered incidentally. Some patients, like in this case, may present with a pulsatile abdominal mass which can easily be mistaken for abdominal aortic aneurysms.