Presentation
Chest and abdominal pain
Patient Data
Isolated spontaneous dissection of the celiac artery with extension to the splenic artery.
Axial CT images reveal a dissection flap separating the true lumen and the false lumen.
Both lumens together are 0.9 cm for the celiac artery and 0.8 cm for the splenic artery.
There is noted a dissection flap in the origin of the left gastric artery suggesting that the artery is also involved in the dissection, followed by thickened wall and narrow lumen.
There are multiple hypodense non-enhancing lesions in the spleen typical to extensive splenic infarction.
The common hepatic artery arises from the superior mesenteric artery(SMA)- normal anatomy variant.
In the segment IVa of the liver there is non enhancement area in both arterial and portal phases about 50 HU, measuring 2.7cm, suggesting liver infarction.
There is also noted right nephrectomy with compensatory hypertrophy of the left kidney (14x6 cm) without signs of hydronephrosis.
White arrows indicate dissection flap of the celiac artery with extension to the splenic artery.
Red arrow indicates dissection flap of the left gastric artery.
Case Discussion
CT findings are compatible with isolated celiac and splenic artery dissection with signs of splenic infarction, there is also signs of left gastric artery dissection.
Arterial dissection is a disruption of the inner layer of the artery.
The frequency of isolated celiac artery dissection is very low and commonly occurs in men.
The most sensitive imaging modality for diagnosis of arterial dissection is contrast-enhanced CT scan with existence of an intimal flap.
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