- 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
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.