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Imaging appearances and management of isolated spontaneous dissection of the superior mesenteric artery.
Eur J Radiol 2007; 64(1):103-10EJ

Abstract

OBJECTIVE

The objective of our study was to report the clinical and imaging features of isolated dissection of the superior mesenteric artery (SMA) and describe our imaging classification of this disease entity.

SUBJECTS AND METHODS

We retrospectively analyzed clinical presentation, imaging appearances and outcome of the 12 patients who were diagnosed as having spontaneous dissection of the SMA from 1991 to 2005 in our institution or its affiliated two hospitals. There were 11 males and 1 female with a mean age of 50 years (range, 43-61 years). The diagnosis of isolated dissection was established with CT within 24h of the onset.

RESULTS

We categorized SMA dissection into the following four types based on imaging appearances: type I, patent false lumen with both entry and re-entry (four patients), type II, 'cul-de-sac' shaped false lumen without re-entry (one patient), type III, thrombosed false lumen with ulcer like projection (ULP), which is defined as a localized blood-filled pouch protruding from the true lumen into the thrombosed false lumen (five patients) and type IV, completely thrombosed false lumen without ULP (two patients). One patient with type II underwent urgent surgery because of small bowel ischemia. One patient with type III underwent urgent embolotherapy for the treatment of rupture of a branch of the SMA. The remaining 10 patients were initially managed conservatively. In one of the conservatively treated patient, ULP had progressively dilated, and it was treated with stent placement and coil packing 22 months after the onset. The remaining nine patients were conservatively managed without any event during the follow-up period of 7-72 months.

CONCLUSION

Most of the patients with isolated SMA dissection can initially be managed conservatively if there are no clinical and imaging signs indicating ruptured SMA branches or bowel ischemia.

Authors+Show Affiliations

Department of Radiology and Radiation Biology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. ichiro-s@net.nagasaki-u.ac.jpNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17628380

Citation

Sakamoto, Ichiro, et al. "Imaging Appearances and Management of Isolated Spontaneous Dissection of the Superior Mesenteric Artery." European Journal of Radiology, vol. 64, no. 1, 2007, pp. 103-10.
Sakamoto I, Ogawa Y, Sueyoshi E, et al. Imaging appearances and management of isolated spontaneous dissection of the superior mesenteric artery. Eur J Radiol. 2007;64(1):103-10.
Sakamoto, I., Ogawa, Y., Sueyoshi, E., Fukui, K., Murakami, T., & Uetani, M. (2007). Imaging appearances and management of isolated spontaneous dissection of the superior mesenteric artery. European Journal of Radiology, 64(1), pp. 103-10.
Sakamoto I, et al. Imaging Appearances and Management of Isolated Spontaneous Dissection of the Superior Mesenteric Artery. Eur J Radiol. 2007;64(1):103-10. PubMed PMID: 17628380.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Imaging appearances and management of isolated spontaneous dissection of the superior mesenteric artery. AU - Sakamoto,Ichiro, AU - Ogawa,Yoji, AU - Sueyoshi,Eijun, AU - Fukui,Kenichiro, AU - Murakami,Tomonori, AU - Uetani,Masataka, Y1 - 2007/07/12/ PY - 2006/11/09/received PY - 2007/04/05/revised PY - 2007/05/31/accepted PY - 2007/7/14/pubmed PY - 2007/12/6/medline PY - 2007/7/14/entrez SP - 103 EP - 10 JF - European journal of radiology JO - Eur J Radiol VL - 64 IS - 1 N2 - OBJECTIVE: The objective of our study was to report the clinical and imaging features of isolated dissection of the superior mesenteric artery (SMA) and describe our imaging classification of this disease entity. SUBJECTS AND METHODS: We retrospectively analyzed clinical presentation, imaging appearances and outcome of the 12 patients who were diagnosed as having spontaneous dissection of the SMA from 1991 to 2005 in our institution or its affiliated two hospitals. There were 11 males and 1 female with a mean age of 50 years (range, 43-61 years). The diagnosis of isolated dissection was established with CT within 24h of the onset. RESULTS: We categorized SMA dissection into the following four types based on imaging appearances: type I, patent false lumen with both entry and re-entry (four patients), type II, 'cul-de-sac' shaped false lumen without re-entry (one patient), type III, thrombosed false lumen with ulcer like projection (ULP), which is defined as a localized blood-filled pouch protruding from the true lumen into the thrombosed false lumen (five patients) and type IV, completely thrombosed false lumen without ULP (two patients). One patient with type II underwent urgent surgery because of small bowel ischemia. One patient with type III underwent urgent embolotherapy for the treatment of rupture of a branch of the SMA. The remaining 10 patients were initially managed conservatively. In one of the conservatively treated patient, ULP had progressively dilated, and it was treated with stent placement and coil packing 22 months after the onset. The remaining nine patients were conservatively managed without any event during the follow-up period of 7-72 months. CONCLUSION: Most of the patients with isolated SMA dissection can initially be managed conservatively if there are no clinical and imaging signs indicating ruptured SMA branches or bowel ischemia. SN - 0720-048X UR - https://www.unboundmedicine.com/medline/citation/17628380/Imaging_appearances_and_management_of_isolated_spontaneous_dissection_of_the_superior_mesenteric_artery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0720-048X(07)00282-3 DB - PRIME DP - Unbound Medicine ER -