Role of imaging in visceral vascular emergencies

Karaosmanoğlu, Ali Devrim; Uysal, Aycan; Akata, Deniz; Ozmen, Mustafa; Karçaaltıncaba, Muşturay

doi:10.1186/s13244-020-00913-3

Cited by 14 publications

(17 citation statements)

References 80 publications

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“…Diagnosis is challenging, and delays in diagnosis carry high mortality. Etiologic factors include atherosclerosis, thrombophilia such as thrombocytosis, protein S, protein C, antithrombin III deficiency, and malignancies [ 7 ]. Patients mostly present with nonspecific abdominal pain, which makes it difficult to differentiate it from benign conditions especially in hemodynamically stable patients.…”

Section: Discussionmentioning

confidence: 99%

Abdominal Pain Caused by Occlusion of the Celiac Trunk and Superior Mesenteric Artery in Addition to Irritable Bowel Syndrome: Case Series and Literature Review

Bakhsh¹,

Khan²,

Bashir³

2021

Cureus

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Irritable bowel syndrome (IBS) is a benign condition of the gastrointestinal tract causing abdominal pain, bloating, diarrhea, and/or constipation. Symptoms of IBS usually improve on passing flatus and defecation. There is no known identifiable underlying pathology; however, several risk factors are known to contribute to the development of IBS, which include a stressful lifestyle and certain foods such as bread, coffee, alcohol, pasta, and chocolates. Intestinal bacteria may also contribute to symptoms of IBS. IBS is diagnosed clinically and treated with various medications to control the symptoms. On the other hand, celiac and mesenteric artery thrombosis (CAMAT) is a condition that may cause significantly higher mortality and morbidity if not recognized early. CAMAT leads to the blockage of major blood vessels to the intestine and several abdominal viscera leading to abdominal pain, nausea, sweating, and, in some cases, symptoms of shock. CAMAT is most likely caused by thrombosis; however, occasionally, embolisms from distant sources in patients with atrial fibrillation can also contribute to the development of CAMAT. CAMAT is usually diagnosed with a computed tomography angiogram (CTA) and treated either surgically or medically with anticoagulants. Vascular thrombus in the thoracic and abdominal region causing ischemia of the stomach and abdominal pain in patients with a history of IBS can easily be missed and cause grave complications with high morbidity and mortality. We present two cases who were initially diagnosed and treated for IBS and later diagnosed with serious intra-abdominal pathology of CAMAT thrombosis.The first case is of a 55-year-old female who was previously diagnosed with IBS and was treated with mebeverine 200mg twice daily and esomeprazole 20mg once daily for 10 weeks. Her pain continued to get worse and she presented to the emergency department by ambulance. She underwent CTA, which showed occlusion of the celiac trunk and superior mesenteric artery causing liver and splenic infarcts. The patient received heparin and underwent a thrombectomy and embolectomy of the superior mesenteric and celiac arteries. No significant abnormality was found in the blood results. Thrombophilia screening was negative. The patient was discharged on warfarin. The second case is of a 53-year-old man who was also initially diagnosed with IBS and was treated with mebeverine 200mg twice daily for eight weeks before presenting to the emergency department with worsening abdominal pain. He underwent a CTA with contrast, which showed occlusion of the common hepatic artery and stenosis of the splenic artery leading to multiple splenic infarcts. No significant abnormality was found in blood test. Thrombophilia screening was negative. He was treated with new anticoagulant medication, dabigatran 150 mg orally twice daily.Both patients were managed with successful outcomes and were discharged home on anticoagulants. There was no recurrence of symptoms at three-month follow-up.These cases highlight that a secondary cause ...

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Section: Discussionmentioning

confidence: 99%

Abdominal Pain Caused by Occlusion of the Celiac Trunk and Superior Mesenteric Artery in Addition to Irritable Bowel Syndrome: Case Series and Literature Review

Bakhsh¹,

Khan²,

Bashir³

2021

Cureus

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“…A critical limb ischemia of a peripheral artery disease was established by arterial Doppler ultrasound, CT angiography, MR angiography or catheter-based arteriography [ 29 ]. Renal artery or vein thrombosis, splanchnic vein thrombosis, cerebral vein thrombosis and thrombosis of aorta and vena cava were defined as filling defects in the corresponding vessel on CT or MR angiography or venography [ 30 , 31 , 32 ]. Other types of thromboembolism, such as retinal vein or artery thrombosis, penis vein thrombosis, osteonecrosis or chronic inflammatory disease, along with pregnancy-related morbidity, were defined by relevant specialists using a referral report.…”

Section: Methodsmentioning

confidence: 99%

Thrombophilia Impact on Treatment Decisions, Subsequent Venous or Arterial Thrombosis and Pregnancy-Related Morbidity: A Retrospective Single-Center Cohort Study

Vrotniakaite-Bajerciene

Tritschler

Jalowiec

et al. 2022

JCM

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(1) Background: Thrombophilia testing utility has remained controversial since its clinical introduction, because data on its influence on treatment decisions are limited. (2) Methods: We conducted a single-center retrospective cohort study of 3550 unselected patients referred for thrombophilia consultation at the Bern University Hospital in Switzerland from January 2010 to October 2020. We studied the influence of thrombophilia testing results on treatment decisions and evaluated the association between thrombophilia and thromboembolic and pregnancy-related morbidity events after testing up to 03/2021. (3) Results: In 1192/3550 patients (34%), at least one case of thrombophilia was found and 366 (10%) had high-risk thrombophilia. A total of 211/3550 (6%) work-ups (111/826 (13%) with low-risk thrombophilia and 100/366 (27%) with high-risk thrombophilia) led to an appropriate decision to extend or initiate anticoagulation, and 189 (5%) negative results led to the withholding of anticoagulation therapy inappropriately. A total of 2492 patients (69%) were followed up for >30 days, with a median follow-up of 49 months (range, 1–183 months). Patients with high-risk thrombophilia had a higher risk of subsequent venous thromboembolic events and pregnancy-related morbidity compared to those without thrombophilia. (4) Conclusions: Our study demonstrated the limited usefulness of thrombophilia work-up in clinical decision-making. High-risk thrombophilia was associated with subsequent venous thromboembolism and pregnancy-related morbidity.

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“…In approximately 75% of the cases, a hematologic abnormality or an underlying thrombotic diathesis can be identified[ 30 , 31 ]. CT clearly shows the obstructed hepatic veins and associating parenchymal changes[ 32 ]. The absence of contrast enhancement in the hepatic vein is the pathognomonic imaging findings on CT[ 12 ].…”

Section: Hepatic Organizationmentioning

confidence: 99%

Clinical anatomy of hepatic vessels by computed tomography angiography: A minireview

Firat¹,

Abbasoglu²,

Karçaaltıncaba³

et al. 2023

World J Radiol

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The liver has a complex vascular anatomy with a unique dual blood supply. Clinical conditions of the liver vary widely and include disorders originating in the vascular and biliary systems as well as the parenchyma. In most vascular disorders, the effects on the liver are generally subclinical because of its abundant blood supply. However, early diagnosis of such vascular diseases can significantly reduce patient morbidity and mortality. Because imaging findings of vascular disease are not always readily apparent, diagnosis can be difficult. Computed tomography angiography is an excellent imaging modality for visualizing the vascular anatomy of patients for treatment planning. In this review article, we focus on the vascular anatomy of the liver and the imaging findings in some acute hepatic vascular diseases.

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Role of imaging in visceral vascular emergencies

Cited by 14 publications

References 80 publications

Abdominal Pain Caused by Occlusion of the Celiac Trunk and Superior Mesenteric Artery in Addition to Irritable Bowel Syndrome: Case Series and Literature Review

Abdominal Pain Caused by Occlusion of the Celiac Trunk and Superior Mesenteric Artery in Addition to Irritable Bowel Syndrome: Case Series and Literature Review

Thrombophilia Impact on Treatment Decisions, Subsequent Venous or Arterial Thrombosis and Pregnancy-Related Morbidity: A Retrospective Single-Center Cohort Study

Clinical anatomy of hepatic vessels by computed tomography angiography: A minireview

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