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Isolated Celiac and Superior Mesenteric Artery Dissection Identified With MDCT: Imaging Findings and Clinical Course

Verde, Franco MD; Bleich, Karen B. MD; Oshmyansky, Alexander MD, PhD; Black, James H. MD; Fishman, Elliot K. MD; Johnson, Pamela T. MD

Journal of Computer Assisted Tomography: September/October 2012 - Volume 36 - Issue 5 - p 539–545
doi: 10.1097/RCT.0b013e318265129e
Abdominal Imaging

Objective: Isolated celiac or superior mesenteric artery (SMA) dissection is a rare entity in the absence of aortic dissection. Our objective was to detail imaging and clinical course of celiac and or SMA dissections.

Methods: We conducted a retrospective search from 2004 to 2010 using “celiac and/or SMA dissection” keywords. Analysis of medical record and imaging at diagnosis and follow-up was performed. Dissections for any reason without aortic dissection were included.

Results: Twenty-four celiac and 18 SMA dissections were detected in 38 patients. One third of the dissections diagnosed with interactive multiplanar reconstruction/maximum intensity projection (MIP)/3-dimensional (3D) rendering were missed on standard imaging planes. No patients had bowel ischemia or died. Eighty-four percent of the patients were observed, 2 patients received anticoagulation, 2 patients received surgical repair, and 3 patients received stenting. Twenty-three of 25 cases treated with observation exhibited no change or improvement/resolution (2/25) with 20.9-month mean follow-up.

Conclusion: Most isolated celiac and SMA dissections were asymptomatic/incidental, supporting observation and surveillance with intervention reserved for vascular compromise. Interactive multiplanar reconstruction/maximum intensity projection/3D rendering can increase diagnostic sensitivity.

From the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD.

Received for publication May 10, 2012; accepted June 18, 2012.

Reprints: Franco Verde, MD, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287 (e-mail: FV fverde1@jhmi.edu).

The authors report no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.