Role of clinical data and multidetector computed tomography findings in acute superior mesenteric artery embolism

Abstract

Background: Superior mesenteric artery embolism (SMAE) has acute onset and fast progression, which seriously threatens the life of patients. Multidetector computed tomography (MDCT) is one of the most important diagnostic methods for SMAE, which plays an important role in the diagnosis and prognosis of SMAE.

Aim: To evaluate the value of combined clinical data and MDCT findings in the diagnosis of acute SMAE and predict the risk factors for SMAE-related death.

Methods: Data from 53 SMAE patients who received abdominal MDCT multi-phase enhancement and superior mesenteric artery digital subtraction angiography examinations were collected. Univariate cox regression and multivariate cox model were used to analyze the correlation between death risk and clinical and computed tomography features in SMAE patients.

Results: Univariate Cox regression model showed that intestinal wall thinning, intestinal wall pneumatosis, blood lactate > 2.1 mmol/L and blood pH < 7.35 increased the risk of death in patients with SMAE. After adjusting for age, sex, embolic involvement length and embolic distribution region, multivariate Cox regression model I showed that blood lactate > 2.1 mmol/L (HR = 5.26, 95%CI: 1.04-26.69, P = 0.045) and intestinal wall thinning (HR = 9.40, 95%CI: 1.05-83.46, P = 0.044) were significantly increases the risk of death in patients with SMAE.

Conclusion: For patients with SAME, increased blood lactate and intestinal wall thinning are the risk factors for death; hence, close monitoring may reduce the mortality rate. Clinical observation combined with MDCT signs can significantly improve SMAE diagnosis.

Keywords: Blood lactate; Embolization; Multidetector computed tomography; Superior mesenteric artery.

Figure 1

An 89 years old male with sudden severe abdominal pain was hospitalized for 1 d. A: The axial image of arterial phase on computed tomography enhanced scan, showing diffuse embolism (long arrow) in superior mesenteric artery III and IV regions; B: An axial image of venous phase, showing thickening of intestinal wall and decreased enhancement (asterisk) at the end of ileum; C: The coronal image of venous phase. It can be seen that the enhancement of ileum is significantly lower than that of normal intestinal wall (arrow); D and E: Volume rendered technique and digital subtraction images, respectively, the proximal ileocolic artery and ileal artery are not displayed.

Figure 2

Male, 71 years old, abdominal pain for 18 h. A: The axial image of enhanced computed tomography in arterial phase; B and D: The axial and coronal images in venous phase; C: The oblique coronal maximum intensity projection image; E: Volume rendered technique; and F: Digital subtraction. It showed diffuse embolism (long arrow) in superior mesenteric artery III and IV regions, accompanied by intestinal wall thickening (asterisk), intestinal wall thinning (slender arrow), decreased enhancement relative to normal intestinal wall (arrow), intestinal cavity expansion and mesenteric fat stranding. Imaging diagnosis of extensive ischemia of small intestine.

Figure 3

The patient was a 62-year-old male with history of abdominal pain, hematochezia, and atrial fibrillation. A and B: The axial images in the arterial phase; C: The axial images in the venous phase; D: The coronary images in the arterial phase; E: The volume rendered technique image; and F: The digital subtraction image. A and D show diffuse embolism in II, III, and IV regions of superior mesenteric artery (long arrows); B shows embolus in the left atrium, C shows decreased intestinal wall enhancement, and signs of pneumatosis intestinalis (arrow).