Superior mesenteric artery stenting for mesenteric ischaemia in Sneddon's syndrome

Mesenteric ischaemia is a rare but serious cause of abdominal pain. We present the case of a man with Sneddon's syndrome, who had symptomatic mesenteric ischaemia secondary to a superior mesenteric artery stenosis in conjunction with a hepatic artery stenosis. As far as the authors are aware, this has not previously been described in Sneddon's syndrome, which is a vascular systemic disease characterized by an association between cerebrovascular accidents and a livedo reticularis skin rash. He was treated with balloon angioplasty and stent insertion, with good symptomatic improvement. This has implications for other stenoses in this condition should they become symptomatic.     

Isolated mesenteric desmoids (mesenteric fibromatosis)

The so-called desmoid tumour is an important member of a group of conditions termed "the fibromatoses" which are characterised by an infiltrating fibroblastic proliferation without features of an inflammatory response. While desmoids most frequently arise in the anterior abdominal wall, they may also be extra-abdominal or intra-abdominal in location. Mesenteric desmoids are relatively rare. They may occur in association with Gardner's syndrome, especially following colectomy, or as an isolated abnormality in otherwise normal patients. In the present paper the authors describe the clinical, radiological and pathological findings in two patients with isolated mesenteric desmoids. The radiological differential diagnosis is also briefly discussed.     

Angioplasty and stenting of the superior mesenteric artery in acute mesenteric ischaemia

Acute mesenteric ischaemia is a challenging diagnostic problem with a very high mortality. Traditionally, laparotomy is required for definitive management. We describe a successful case of angioplasty and stenting of the superior mesenteric artery in a surgically unfit patient. We recommend that stenting be considered only in situations where the diagnosis has been made prior to bowel infarction, and if the patient poses a poor operative risk.     

CT in acute mesenteric ischaemia

Enhanced computed tomography (CT) is frequently performed for possible bowel ischaemia. It has the distinct advantage of possible detection of the causes of ischaemia. Radiologists therefore need to be familiar with the spectrum of diagnostic CT signs. We present the CT imaging findings in surgically proven cases of small bowel ischaemia. In addition to signs pertaining to the underlying aetiological pathology, bowel dilatation, bowel wall thickening, mural gas, occlusion of mesenteric vessels, ascites and infarct of other abdominal organs were observed.     

Heterotopic mesenteric ossification

We report a case of heterotopic bone formation in the mesentery. A 64-year-old man presented with abdominal pain and stiffness two months after undergoing several surgical interventions for hemorrhagic colitis. The diagnosis was heterotopic mesenteric ossification. We describe the imaging findings and review the literature.     

肠系膜上动、静脉血栓形成的CT诊断

肠系膜上动、静脉血栓形成临床上比较少见，由于其症状和体征不典型，常易误诊，且死亡率较高。笔者遇到9例经CT发现的肠系膜上静脉血栓形成和4例肠系膜上动脉血栓形成病例，并经临床、手术及病理证实，现报告如下。     

Biphasic CT with mesenteric CT angiography in the evaluation of acute mesenteric ischemia: initial experience

PURPOSE: To evaluate the sensitivity and specificity of biphasic computed tomography (CT) with mesenteric CT angiography in the diagnosis of acute mesenteric ischemia (AMI). MATERIALS AND METHODS: Sixty-two patients with clinically suspected AMI underwent prospective imaging with biphasic multi-detector row CT. Mesenteric CT angiography was performed with 1.25-mm collimation starting 25 seconds after 140 mL of intravenous contrast agent was administered at a rate of 4 mL/sec, followed by portal venous phase imaging with 5-mm collimation and a 60-70-second delay. CT angiograms were reconstructed with multiplanar (including transverse), maximum intensity projection, and volume-rendered techniques. All scans were evaluated prospectively by two independent radiologists for CT evidence of ischemia. AMI was confirmed with surgical or pathologic proof in 25 of 26 patients. In one patient, AMI was confirmed with clinical findings and serial CT examinations. In patients with AMI, sensitivity and specificity of each CT sign were calculated retrospectively by using patients who did not have intestinal ischemia as a control group. CT criteria that optimized sensitivity and specificity for the diagnosis of AMI were then developed. RESULTS: AMI was diagnosed in 26 patients. The CT angiogram depicted arterial disease in eight patients and altered care in five. A finding of any one of pneumatosis intestinalis, venous gas, superior mesenteric artery occlusion, celiac and inferior mesenteric artery occlusion with distal SMA disease, or arterial embolism was 100% specific but only 73% sensitive. Alternatively, a finding of bowel wall thickening in addition to focal lack of bowel wall enhancement, solid organ infarction, or venous thrombosis was 50% sensitive and 94% specific. By using either of these criteria for the diagnosis, a sensitivity of 96% and a specificity of 94% can be achieved. CONCLUSION: Biphasic CT with mesenteric CT angiography is effective in the diagnosis of AMI.     

Primary mesenteric rhabdomyosarcoma in paediatric patient

Primary mesenteric rhabdomyosarcoma is an exceptional entity in adult and paediatric patients. We report and discuss the imaging findings in a 2 year-old child with an abdominal mass. Our case showed similar imaging findings to rhabdomyosarcoma in other locations.     

急性肠系膜血管梗塞的CT表现

目的评价CT对急性肠系膜血管梗塞（AMI）的诊断价值。方法搜集AMI病例10例，男6例，女4例，平均年龄67．2岁。除1例在诊断次日死亡外，其余均经手术病理证实。其中肠系膜上动脉（SMA）梗塞4例，肠系膜上静脉梗塞（SMV）5例，肠系膜下静脉（IMV）梗塞1例。除1例行CT平扫外，其余9例均行CT平扫及增强扫描，详细分析其影像学表现。结果直接征象为血管内充盈缺损（8例）。间接征象包括肠腔扩张积液（4例）、肠壁增厚（6例）、薄纸样肠壁（4例）、缆绳征（5例）、肠系膜积液（3例）、肠壁积气（2例）、门静脉积气（1例）及腹腔积液（3例）。结论CT是诊断急性肠系膜血管梗塞的一种快速、敏感、可靠及无创伤的影像学方法。     

CT appearance of mesenteric saponification

Although saponification of the pancreas is a frequent finding on computed tomography, saponification of extrapancreatic mesenteric sites has not been previously recognized. A case is presented of acute pancreatitis in which serial scans over a four-year period documented calcifications in old extrapancreatic phlegmons. Saponification from pancreatitis should be considered in the differential diagnosis of mesenteric calcifications.     

Computed tomography of mesenteric disease

Inflammation, edema, and neoplasms may directly involve the mesentery. Here, the authors illustrate the varied CT appearances of such mesenteric abnormalities.