Acute mesenteric ischemia

  • Arterial embolism or thrombosis, venous occlusion or low-flow states
  • Severe abdominal pain at presentation
  • MDCT crucial for diagnosis. Oral water with i.v. contrast and dual phase imaging. Sensitivity 93%. Specificity 96%
  • Acute transmural infarction: mural thinning, small intestine dilatation, reduced or absent mural enhancement 
  • Non-occlusive mesenteric ischemia: mural thickening, mucosal hyper enhancement. 
  • Mesenteric venous thrombosis: marked mural thickening, mucosal hyper enhancement, mesenteric stranding, vascular engorgement
  • Ascites in 2/3 of patients, mainly in venous thrombosis
  • Cardioembolic: signs of solid visceral infarcts. Segmental bowel involvement. 
  • Pneumatosis intestinalis and portal venous gas – earlier considered to be specific for ischemia but no longer the case. Differentials: infection, inflammation, neoplasia, asthma, bowel dissension, raised intraluminal pressure
Read more

Cognet, François, et al. “Chronic mesenteric ischemia: imaging and percutaneous treatment.” Radiographics 22.4 (2002): 863-879.

Kanasaki, Shuzo, et al. “Acute mesenteric ischemia: multidetector CT findings and endovascular management.” Radiographics 38.3 (2018): 945-961.