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Case Reports
. 2023 Jul 22;18(10):3390-3394.
doi: 10.1016/j.radcr.2023.06.064. eCollection 2023 Oct.

Could CT finding of gas in the sole mesenteric artery be a sign of a severe acute ischemia? Presentation of a rare fatal case and a literature review

Valerio D'Agostino  1 , Luigi Coppola  2 , Angela Barillaro  3 , Mariateresa Spaziano  1 , Nicola Bonacci  1 , Stefania Castaldo  4 , Ciro Nappa  3 , Giovanna Iacuessa  3 , Fabio Cerrone  3 , Antonio Salzano  1
Affiliations
Case Reports

Could CT finding of gas in the sole mesenteric artery be a sign of a severe acute ischemia? Presentation of a rare fatal case and a literature review

Valerio D'Agostino et al. Radiol Case Rep. .

Abstract

Contrast-enhanced abdominal CT is the gold standard for the diagnosis of acute mesenteric ischemia (AMI). CT findings include several anomalies like bowel wall thickening, thinning, attenuation, decreased enhancement, dilated fluid-filled loops, pneumatosis, and portal venous gas. A rare case of gas found only in the superior mesenteric artery (SMA) is presented. A contrast-enhanced CT scan was performed in emergency on an 80-year-old man with vague and diffuse abdominal pain, which showed findings of occlusive AMI. Gas was found in the context of the SMA and its branches, but not in the mesenteric and portal veins. The patient underwent emergency surgery but he died the next day in the intensive care unit for complications. The rare CT finding of gas in SMA during an AMI should be considered a radiological sign of irreversible intestinal damage: surgical prompt intervention is needed, even if the mortality rate is high.

Keywords: Abdominal CT; Arterial gas; Bowel necrosis; Emergency radiology; Mesenteric Ischemia.

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Figures

Fig 1
Fig. 1
(A) CT axial image in the portal phase showing filling defect in both SMV (blue arrow) and SMA (red arrow), with the presence of gas within the latter. Moreover, the presence of small bowel loops with thinned walls and lack of enhancement (orange arrow) if compared to normal bowel (green arrow) is shown. (B) CT axial reformatted image with minimum intensity projection (minIP) highlighting the diffuse presence of intra-arterial mesenteric gas resembling the branches of a tree (white arrow), alongside the presence of gas within the bowel's wall (black arrow) consistent with pneumatosis intestinalis.
Fig 2
Fig. 2
(A) CT coronal image in the portal phase showing an extensive filling defect in SMA (white arrow), with the presence of endoluminal gas. (B) CT coronal reformatted image with minimum intensity projection (minIP) which depicts nicely the tree-like distribution of gas in SMA and its collaterals.
Fig 3
Fig. 3
Operative photography prior of the multiple bowel loops resection, which looked severely and extensively pale, atonic, and enlarged.
See this image and copyright information in PMC

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