Could CT finding of gas in the sole mesenteric artery be a sign of a severe acute ischemia? Presentation of a rare fatal case and a literature review

Valerio D'Agostino; Luigi Coppola; Angela Barillaro; Mariateresa Spaziano; Nicola Bonacci; Stefania Castaldo; Ciro Nappa; Giovanna Iacuessa; Fabio Cerrone; Antonio Salzano

doi:10.1016/j.radcr.2023.06.064

Could CT finding of gas in the sole mesenteric artery be a sign of a severe acute ischemia? Presentation of a rare fatal case and a literature review

Radiol Case Rep. 2023 Jul 22;18(10):3390-3394. doi: 10.1016/j.radcr.2023.06.064. eCollection 2023 Oct.

Affiliations

¹ Department of Radiology, Sessa Aurunca Hospital, Sessa Aurunca, Caserta, Italy.
² Department of Radiology, Maddaloni Hospital, Caserta, Italy.
³ Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.
⁴ Department of Radiology, University of Trieste, ASUGI, Cattinara Hospital, Trieste, Italy.

Abstract

Contrast-enhanced abdominal CT is the gold standard for the diagnosis of acute mesenteric ischemia (AMI). CT findings include several anomalies like bowel wall thickening, thinning, attenuation, decreased enhancement, dilated fluid-filled loops, pneumatosis, and portal venous gas. A rare case of gas found only in the superior mesenteric artery (SMA) is presented. A contrast-enhanced CT scan was performed in emergency on an 80-year-old man with vague and diffuse abdominal pain, which showed findings of occlusive AMI. Gas was found in the context of the SMA and its branches, but not in the mesenteric and portal veins. The patient underwent emergency surgery but he died the next day in the intensive care unit for complications. The rare CT finding of gas in SMA during an AMI should be considered a radiological sign of irreversible intestinal damage: surgical prompt intervention is needed, even if the mortality rate is high.

Keywords: Abdominal CT; Arterial gas; Bowel necrosis; Emergency radiology; Mesenteric Ischemia.

Publication types

Case Reports