Clinical Presentation, Imaging, and Management of Segmental Arterial Mediolysis: A Rare Vascular Disorder

Abstract Objectives Our objective was to analyze the clinical presentation, imaging findings, and the management of segmental arterial mediolysis (SAM) in different case scenarios within our medical institution. Materials and Methods We retrospectively analyzed 13 cases of SAM in our institution from July 2017 to March 2020. The images from the cases were collected from picture archiving and communication system (PACS) along with other pertinent clinical information from the hospital's information system. All the patients we studied underwent contrast-enhanced computed tomography (CT) using a third-generation Siemens SOMATOM Force dual-source CT scanner. Once the dual-phase scanning was completed, the images were analyzed using the workstation's syngo.via software. Results Three out of the 13 cases required stent-grafting of the renal/celiac artery, and the involved branch of the superior mesenteric artery was embolized in one case. The rest of the cases were managed conservatively with antiplatelets/anticoagulants. Subsequent follow-ups of the patients were conducted and showed stabilization/regression of the initial findings without finding any evidence of worsening. Conclusion SAM should be considered when making a differential diagnosis of acute abdominal pain when associated with dissection or aneurysms in splanchnic arteries, and in cases of unexplained intra-abdominal hemorrhaging. The radiologist needs to be aware of this possibility to raise suspicion, alert the clinician, and guide appropriate management.

Download Full-text

A Case of Isolated Celiac Artery Dissection Accompanied by Splenic Infarction Detected by Ultrasonography in the Emergency Department

Case Reports in Cardiology ◽

10.1155/2016/8608496 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Kazumasa Emori ◽

Nobuhiro Takeuchi ◽

Junichi Soneda

Keyword(s):

Emergency Department ◽

Celiac Artery ◽

Splenic Infarction ◽

Artery Dissection ◽

Emergency Setting ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

History Of ◽

Enhanced Computed Tomography

A 46-year-old male with a history of hypertension visited the emergency department (ED) by ambulance complaining of sudden pain in the left side of his back. Ultrasonography (USG) performed at ED revealed splenic infarction along with occlusion and dissection of the celiac and splenic arteries without abdominal artery dissection. Contrast enhanced computed tomography (CT) revealed the same result. Consequently, spontaneous isolated celiac artery dissection (SICAD) was diagnosed. Because his blood pressure was high (159/70 mmHg), antihypertensive medicine was administered (nicardipine and carvedilol). After his blood reached optimal levels (130/80 mmHg), symptoms disappeared. Follow-up USG and contrast enhanced CT performed 8 days and 4 months after onset revealed amelioration of splenic infarction and improvement of the narrowed artery. Here, we report a case of SICAD with splenic infarction presenting with severe left-sided back pain and discuss the relevance of USG in an emergency setting.

Download Full-text

A Case of Successful Treatment of Ruptured Pancreaticoduodenal Artery Aneurysm Caused by Celiac Artery Dissection

Case Reports in Gastroenterology ◽

10.1159/000491384 ◽

2018 ◽

Vol 12 (2) ◽

pp. 385-389 ◽

Cited By ~ 1

Author(s):

Naruhiro Kimura ◽

Atsunori Tsuchiya ◽

Akihiro Nakamura ◽

Muneatsu Ueda ◽

Seiichi Yoshikawa ◽

...

Keyword(s):

Artery Aneurysm ◽

Celiac Artery ◽

Artery Dissection ◽

Angiographic Embolization ◽

Pancreaticoduodenal Artery ◽

Contrast Enhanced ◽

Head Of The Pancreas ◽

Pancreaticoduodenal Artery Aneurysm ◽

Enhanced Computed Tomography

A 52-year-old man was admitted due to severe epigastric lesion pain. Esophagus gastroduodenal endoscopy showed impaired duodenal dilatation, and contrast-enhanced computed tomography revealed a pancreaticoduodenal artery (PDA) aneurysm 13 mm in diameter below the head of the pancreas, retroperitoneal hematoma, idiopathic celiac artery (CA) dissection, and common hepatic artery disruption. Angiographic embolization with a mixture of N-butyl-1,2-cyanoacrylate and lipiodol was performed, and follow-up study showed improvement of the dilatation of the duodenum and disappearance of the aneurysm. Here we report a quite rare case of PDA aneurysm by idiopathic dissection of CA treated successfully with angiographic embolization.

Download Full-text

Atypical Presentation of IgA Nephropathy Mimicking Acute Pyelonephritis

Case Reports in Medicine ◽

10.1155/2018/9231989 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3

Author(s):

Stamatis Karakonstantis ◽

Despoina Galani ◽

Dafni Korela ◽

Sofia Pitsigavdaki ◽

Ifigeneia Kassotaki ◽

...

Keyword(s):

Red Blood Cells ◽

Iga Nephropathy ◽

Acute Pyelonephritis ◽

Blood Cells ◽

Clinical Presentation ◽

Left Kidney ◽

Flank Pain ◽

Contrast Enhanced ◽

Enhanced Computed Tomography ◽

Contrast Enhanced Computed Tomography

Background. IgA glomerulonephritis may present with hematuria, flank pain, and fever. This clinical presentation may be easily confused with acute pyelonephritis.Case Report. We present the case of a 25-year-old female with a typical clinical presentation for acute pyelonephritis (high fever, left flank pain, left costovertebral angle tenderness, hematuria, elevated inflammatory markers, and a hypoenhancing region in the left kidney on contrast-enhanced computed tomography). However, urine and blood cultures were both negative, the serum creatinine was elevated, and the urinalysis revealed significant proteinuria and dysmorphic red blood cells. A kidney biopsy confirmed a diagnosis of IgA nephropathy. She was treated with a combination of lisinopril and methylprednisolone, with good response.Conclusion. Gross hematuria, especially in the absence of pyuria or bacteriuria, should raise the suspicion for underlying IgA nephropathy, even if the rest of the clinical presentation is typical for a urinary tract infection. The presence of significant proteinuria, red blood cell casts, and dysmorphic red blood cells are useful clues suggesting glomerular disease.

Download Full-text

Transarterial Embolization With Complementary Surgical Ligation of Gastroduodenal Artery for Ruptured Pancreaticoduodenal Artery Aneurysm

Vascular and Endovascular Surgery ◽

10.1177/1538574419859693 ◽

2019 ◽

Vol 53 (7) ◽

pp. 593-598 ◽

Cited By ~ 1

Author(s):

Toru Imagami ◽

Satoru Takayama ◽

Taku Hattori ◽

Ryohei Matsui ◽

Hisanori Kani ◽

...

Keyword(s):

Aortic Dissection ◽

Acute Aortic Dissection ◽

Transarterial Embolization ◽

Artery Aneurysm ◽

Celiac Artery ◽

Gastroduodenal Artery ◽

Contrast Enhanced ◽

Pancreaticoduodenal Artery Aneurysm ◽

Enhanced Computed Tomography ◽

Contrast Enhanced Computed Tomography

The association between pancreaticoduodenal artery aneurysm (PDAA) and local hemodynamic changes in pancreaticoduodenal arcades is well established. However, there are few case reports of PDAA associated with acute aortic dissection. In this article, we outline and discuss the case of a 61-year-old man diagnosed with a type A acute aortic dissection who underwent emergency surgery and developed sudden-onset severe abdominal pain and shock 10 days later. Contrast-enhanced computed tomography showed a ruptured PDAA with feeding vessels from the gastroduodenal and superior mesenteric arteries, with evidence that the celiac artery was diverged from a false lumen. Transarterial embolization via the superior mesenteric artery alone was not expected to achieve hemostasis, so we performed a hybrid procedure involving transarterial embolization cannulated from superior mesenteric artery with complementary surgical ligation of the gastroduodenal artery. The postoperative course was uneventful, and follow-up contrast-enhanced computed tomography showed no persistence of the aneurysm 8 days after the second operation. This case proposed that visceral arterial malperfusion due to acute aortic dissection can cause PDAA in the early postoperative period. Although previous reports suggest that endovascular treatment is preferable, it may not always be feasible. Since ruptured PDAAs are often not detected during surgery, surgical treatment can be overly invasive. Whereas, transarterial embolization with complementary clamping or ligation of the gastroduodenal artery for ruptured PDAA is less invasive and can control hemorrhage, especially when cannulation to the celiac artery is impossible. Notably, the technique did not cause organ ischemia, presumably because the small collateral vessels of the pancreaticoduodenal arcades permitted sufficient blood flow. If endovascular treatment is unable to achieve rapid hemostasis, this technique may be a useful option for ruptured PDAA.

Download Full-text

Stump appendicitis

International Surgery Journal ◽

10.18203/2349-2902.isj20202872 ◽

2020 ◽

Vol 7 (7) ◽

pp. 2461

Author(s):

Ketan Vagholkar

Keyword(s):

Computed Tomography ◽

Acute Appendicitis ◽

Clinical Presentation ◽

Abdominal Operation ◽

Diagnosis And Management ◽

Stump Appendicitis ◽

Contrast Enhanced ◽

The World ◽

Enhanced Computed Tomography ◽

Contrast Enhanced Computed Tomography

Appendectomy is one of the commonest abdominal operation performed all over the world. Stump appendicitis is one of the uncommon complications of appendectomy. The diagnosis of stump appendicitis is delayed due to low index of suspicion by virtue of the fact that an appendectomy has already been done. The clinical presentation exactly simulates acute appendicitis. Contrast enhanced computed tomography is diagnostic. Completion appendectomy either open or laparoscopic is the mainstay of treatment. Awareness regarding the possible aetiology, diagnosis and management is essential for avoiding delay in the diagnosis.

Download Full-text

Acute Focal Bacterial Nephritis: Two Cases and Review of the Literature

Canadian Journal of Kidney Health and Disease ◽

10.1177/2054358119884310 ◽

2019 ◽

Vol 6 ◽

pp. 205435811988431

Author(s):

Adnane Guella ◽

Arshee Khan ◽

Dima Jarrah

Keyword(s):

Computed Tomography ◽

Clinical Presentation ◽

Renal Scarring ◽

Lessons Learned ◽

Antibiotic Administration ◽

Contrast Enhanced ◽

Enhanced Computed Tomography ◽

Acute Focal Bacterial Nephritis ◽

Contrast Enhanced Computed Tomography ◽

Worse Prognosis

Rationale: Acute focal bacterial nephritis (AFBN) has mainly been reported in pediatrics. It may be an underdiagnosed condition in adults because it resembles acute pyelonephritis (APN) in its clinical presentation. Presenting concerns of the patients: Two young women (25 and 27 years old, respectively) presented with complaints compatible with a diagnosis of APN. However in both, fever was of high grade, persistent for several days in spite of antibiotic administration, and there was demonstrated worsening of the inflammatory biomarkers. A contrast-enhanced computed tomography (CECT) led to the diagnosis in both cases. Diagnoses: Contrast-enhanced computed tomography reveals the most sensitive and specific images of AFBN. This includes wedge-shaped lesions with decreased enhancement, which may be focal or multifocal. Interventions (including prevention and lifestyle): Antibiotic therapy for at least 3 weeks. Outcomes: Resolution of AFBN was obtained after 3 weeks of antibiotics. Lessons learned: Our 2 cases illustrate the importance of CECT imaging to confirm the diagnosis of AFBN. Interstitial bacterial inflammation may have a worse prognosis if not diagnosed early and efficiently treated. Unlike APN, the management of AFBN requires at least 3 weeks of antibiotics to prevent the development of renal scarring and renal abscess.

Download Full-text

Orbital Metastasis as Initial Clinical Presentation in a Patient of Hepatocellular Carcinoma – A Rare Case with Review of Literature

Indian Journal of Medical and Paediatric Oncology ◽

10.1055/s-0041-1736682 ◽

2021 ◽

Vol 42 (04) ◽

pp. 385-389

Author(s):

Sakshi Rana ◽

Divya Khosla ◽

Kannan Periasamy ◽

Rakesh Kapoor ◽

Sunny Bhardwaj ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Clinical Presentation ◽

Palliative Radiotherapy ◽

Intracranial Extension ◽

Orbital Metastasis ◽

Left Frontal Lobe ◽

Contrast Enhanced ◽

Rare Manifestation ◽

History Of ◽

Enhanced Computed Tomography

AbstractOrbital metastasis, as the initial clinical presentation in hepatocellular carcinoma (HCC), is a rare manifestation. A 66-year-old male patient presented with a history of protrusion of the eyeballs, double vision, and swelling over the left side of the head for 8 months. Magnetic resonance imaging of the brain with orbit revealed a heterogeneous lesion in the left frontal lobe causing its destruction with intraorbital and intracranial extension. Triphasic contrast-enhanced computed tomography was suggestive of multiple hypodense areas in both lobes of the liver. Tissue diagnosis from the liver was suggestive of HCC. A diagnosis of multifocal HCC with orbital metastasis was made. The patient was treated with palliative radiotherapy and sorafenib. Orbital metastasis in HCC is rare. Prognosis is somber in such cases. The treatment should focus on providing palliation from symptoms.

Download Full-text

Computer-Aided Diagnosis in Jaundice: Comparison of Knowledge-based and Probabilistic Approaches

Methods of Information in Medicine ◽

10.1055/s-0038-1634634 ◽

1996 ◽

Vol 35 (01) ◽

pp. 41-51 ◽

Cited By ~ 3

Author(s):

F. Molino ◽

D. Furia ◽

F. Bar ◽

S. Battista ◽

N. Cappello ◽

...

Keyword(s):

Clinical Presentation ◽

Clinical Information ◽

Diagnostic Value ◽

Clinical Findings ◽

Clinical Documentation ◽

Data Set ◽

Knowledge Based ◽

Number Of Patients ◽

Support Tools ◽

Aided Diagnosis

AbstractThe study reported in this paper is aimed at evaluating the effectiveness of a knowledge-based expert system (ICTERUS) in diagnosing jaundiced patients, compared with a statistical system based on probabilistic concepts (TRIAL). The performances of both systems have been evaluated using the same set of data in the same number of patients. Both systems are spin-off products of the European project Euricterus, an EC-COMACBME Project designed to document the occurrence and diagnostic value of clinical findings in the clinical presentation of jaundice in Europe, and have been developed as decision-making tools for the identification of the cause of jaundice based only on clinical information and routine investigations. Two groups of jaundiced patients were studied, including 500 (retrospective sample) and 100 (prospective sample) subjects, respectively. All patients were independently submitted to both decision-support tools. The input of both systems was the data set agreed within the Euricterus Project. The performances of both systems were evaluated with respect to the reference diagnoses provided by experts on the basis of the full clinical documentation. Results indicate that both systems are clinically reliable, although the diagnostic prediction provided by the knowledge-based approach is slightly better.

Download Full-text