Isolated superior mesenteric artery dissection

Case contributed by Dr Salman S. Albakheet

Presentation

Status post cardiac catheterization one year back, presents with history of vague abdominal pain for 4 days with frequent ER visits, CT scan done to rule out mesenteric ischemia.

Patient Data

Age: 45
Gender: Male

Abdomen and pelvis CT scan

CT

Evidence of thrombus seen in the superior mesenteric artery at the segment just below the origin which causing 70 to 75 % occlusion associated with intimal flap originated from the area of thrombus which is dividing the superior mesenteric artery into 2 lumens. The largest one which is present the false lumen and the attenuated one is the true lumen. Perivascular fat stranding is seen around the superior mesenteric artery.

The aorta itself showing no evidence of dissection. The small and large bowel loops show normal wall thickness and enhancement.

Case Discussion

Isolated dissection of the main trunk of the superior mesenteric artery (SMA) without aortic involvement is an unusual condition and the involvement of the intestinal blood supply is a major cause of death.

Sometimes this condition may resolve spontaneously, but usually, when dissection of SMA occurs, the mortality rate is high. Therefore, it is important to make an early diagnosis.

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