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Acute mesenteric ischemia

Nieman CMN - MedPix

View Article: MedPix Image - MedPix Case

Affiliation: Brooke Army Medical Center

ABSTRACT

Diagnosis: Acute mesenteric ischemia

History: Middle aged man presents with acute onset abdominal pain which is "out of proportion" to physical exam.

Findings: Axial images from enhanced CT of the abdomen demonstrate thrombus occluding the celiac plexus and the distal superior mesenteric artery. No focal bowel wall thickening, pneumatosis intestinalis, venous gas, solid organ infarction or venous thrombosis was seen. Angiography confirmed these occlusions and diagnosed an unsuspected high grade AV fistula of a jejunal artery to a jejunal vein. The etiology of this fistula remains unknown.

Ddx: Occlusive acute mesenteric ischemia: 1. Emboli (atrial fibrillation, ventricular aneurysm) 2. Arterial thrombosis (atherosclerotic) 3. Venous thrombosis (portal hypertension, pancreatitis, tumor) Non-occlusive AMI: 1. Hypoperfusion 2. Hypovolemia

Dxhow: Surgery.

Exam: Other than complaining of pain, the patient appeared to be clinically well. His abdomen was soft, relatively non-tender to palpation without involuntary guarding or rebound tenderness. Serum lactate mildly elevated. No electrolyte abnormality. No acute decrease in hemoglobin or hematocrit.

No MeSH data available.


Super-selective superior mesenteric arteriogram demonstrating the high grade AV fistula of a jejunal artery with a jejunal vein with an interconnecting aneurysm (obliqued view).
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MPX2413_synpic19343: Super-selective superior mesenteric arteriogram demonstrating the high grade AV fistula of a jejunal artery with a jejunal vein with an interconnecting aneurysm (obliqued view).


Acute mesenteric ischemia

Nieman CMN - MedPix

Super-selective superior mesenteric arteriogram demonstrating the high grade AV fistula of a jejunal artery with a jejunal vein with an interconnecting aneurysm (obliqued view).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX2413&req=5

MPX2413_synpic19343: Super-selective superior mesenteric arteriogram demonstrating the high grade AV fistula of a jejunal artery with a jejunal vein with an interconnecting aneurysm (obliqued view).

View Article: MedPix Image - MedPix Case

Affiliation: Brooke Army Medical Center

ABSTRACT

Diagnosis: Acute mesenteric ischemia

History: Middle aged man presents with acute onset abdominal pain which is "out of proportion" to physical exam.

Findings: Axial images from enhanced CT of the abdomen demonstrate thrombus occluding the celiac plexus and the distal superior mesenteric artery. No focal bowel wall thickening, pneumatosis intestinalis, venous gas, solid organ infarction or venous thrombosis was seen. Angiography confirmed these occlusions and diagnosed an unsuspected high grade AV fistula of a jejunal artery to a jejunal vein. The etiology of this fistula remains unknown.

Ddx: Occlusive acute mesenteric ischemia: 1. Emboli (atrial fibrillation, ventricular aneurysm) 2. Arterial thrombosis (atherosclerotic) 3. Venous thrombosis (portal hypertension, pancreatitis, tumor) Non-occlusive AMI: 1. Hypoperfusion 2. Hypovolemia

Dxhow: Surgery.

Exam: Other than complaining of pain, the patient appeared to be clinically well. His abdomen was soft, relatively non-tender to palpation without involuntary guarding or rebound tenderness. Serum lactate mildly elevated. No electrolyte abnormality. No acute decrease in hemoglobin or hematocrit.

No MeSH data available.