Isolated spontaneous dissection of a visceral artery: a rare cause of epigastric pain.

Abstract

Isolated spontaneous dissection of the celiac trunk or superior mesenteric artery is rarely considered in patients with acute abdominal pain. However, with advances in computed tomography (CT) technology, more cases are being detected. The aim of this study was to describe the clinical manifestation and the classical CT features of isolated spontaneous celiac trunk and superior mesenteric artery (SMA) dissection. The records of seven patients were reviewed to assess demographic data, presenting symptoms, location of dissection, diagnostic modalities, imaging findings, complications, and treatment. Six patients were men. The average age was 57 years (range, 44-80). Six had epigastric pain and one was asymptomatic. All were diagnosed by CT. The location of dissection was the celiac trunk in three and SMA in four. In all cases, the diagnosis was made by identifying an intimal flap on contrast-enhanced CT images. Extension of dissection to the hepatic artery was found in three patients. A number of associated imaging findings were also present: infiltration of the fat surrounding the vessel (four cases), aneurysmal dilatation (six), thrombosed false lumen (four), significant stenosis (two), and additional aortic or visceral artery aneurysm (four). One patient had renal infarction 2 weeks after initial presentation. Extensive evaluation of all patients revealed no serologic evidence to support the presence of vasculitis or an inflammatory disorder. All were treated conservatively with antihypertensive drugs, anti-inflammatory drugs, steroids, and anticoagulants. Isolated spontaneous splanchnic artery dissection should be considered in the differential diagnosis of acute abdominal pain.