eMedicine Specialties > Radiology > Gastrointestinal
Mesenteric Ischemia: Multimedia
Updated: Dec 18, 2008
Multimedia
 | Media file 1: Mesenteric ischemia. Plain abdominal radiograph in a 49-year-old woman with acute bloody bowel movements shows thumbprinting of the transverse colon. Differential diagnosis included inflammatory/infectious versus ischemic disease. A CT scan was obtained (see Image below). |
 | Media file 2: Mesenteric ischemia. CT scan in a 49-year-old woman with acute bloody bowel movements (same patient as in Image above) shows thickening of the transverse colon, which is correlated with the plain radiographic findings. These findings suggest a distribution in the superior mesenteric artery territory. |
 | Media file 3: Mesenteric ischemia. CT scan in an 81-year-old man with abdominal pain and diarrhea shows wall thickening of the ascending colon. This finding also can be seen with infectious colitis; however, assay results for Clostridium difficile were negative. The cause is likely atherosclerotic in origin because of the patient's age and because of the partially calcified aorta. |
 | Media file 4: Mesenteric ischemia. CT scan in a 72-year-old man with bright-red blood per rectum and abdominal pain shows thickening of the ascending colon and hepatic flexure. The differential diagnoses included conditions with an infectious etiology versus ischemia. Magnetic resonance angiography was performed, and images showed stenosis at the origin of the superior mesenteric artery. |
 | Media file 5: Mesenteric ischemia. CT scan in a 56-year-old woman with abdominal pain and a family history of colon cancer shows inflammatory changes and thickening of the hepatic flexure, initially believed to represent cancer. Colonoscopy with biopsy showed focal mucosal necrosis with ulceration consistent with ischemic colitis, which likely is caused by a small contributing vessel, since it is only seen focally at the hepatic flexure. |
 | Media file 6: Mesenteric ischemia. Plain abdominal radiograph in a 17-year-old male patient with encephalitis reveals pneumatosis of the colon dissecting the bowel wall. CT scan revealed the extent of pneumatosis (see Image below). |
 | Media file 7: Mesenteric ischemia. CT scan obtained by using lung window parameters in a 17-year-old male patient with encephalitis reveals free retroperitoneal air (same patient as in Image above). |
 | Media file 8: Mesenteric ischemia. CT scan in a 17-year-old male patient with encephalitis shows the true extent of the pneumatosis with curvilinear air collections in the colonic wall (same patient as in the 2 Images above). Note how the use of lung windows for abdominal CT makes the intramural air more detectable. |
 | Media file 9: Mesenteric ischemia. CT scan in a 76-year-old woman with a 4-day history of abdominal pain and leukocytosis shows congested, edematous, central small bowel loops. Thrombosis was found in the superior mesenteric vein (also see the 2 Images that follow). |
 | Media file 10: Mesenteric ischemia. CT scan in a 76-year-old woman with a 4-day history of abdominal pain and leukocytosis reveals a hypoattenuating thrombus in an enhanced superior mesenteric vein, revealing a venous source of the small bowel ischemia (same patient as in the Image above and the Image below). A resultant cavernous transformation is seen in the Image below. |
 | Media file 11: Mesenteric ischemia. CT scan in a 76-year-old woman with a 4-day history of abdominal pain and leukocytosis shows cavernous transformation of the portal vein with abundant collateral vessels, causing venous congestion of the small bowel mesentery. This is likely secondary to thrombus in the portal vein (same patient as in the 2 Images above). |
 | Media file 12: Mesenteric ischemia. CT scan in a 36-year-old woman with abdominal pain and guaiac-positive stool from her colostomy shows portal-venous air in the left hepatic lobe. Pneumatosis of the small bowel was present, consistent with small bowel infarction. |
 | Media file 13: Mesenteric ischemia. CT scan in a 59-year-old man with pancreatic adenocarcinoma shows a large mass encasing the superior mesenteric artery. The patient did not have abdominal symptoms of ischemia because the superior mesenteric artery remained patent. Tumor encasement is a rare cause of mesenteric ischemia. |
 | Media file 14: Mesenteric ischemia. Ultrasonographic evaluation with spectral analysis and color Doppler imaging in a 64-year-old man shows a typical normal pattern. |
 | Media file 15: Mesenteric ischemia. Ultrasonographic evaluation with spectral analysis and color Doppler imaging in a 64-year-old man shows a typical normal pattern of response. The normal postprandial response of the celiac artery shown here is an increase in the peak systolic velocity, suggesting patency of flow. An abnormal response would be a blunted increase in the peak systolic velocity in response to eating, indicating stenosis. |
 | Media file 16: Mesenteric ischemia. Ultrasonographic evaluation in an 83-year-old woman with abdominal pain reveals multiple echogenic foci within the liver, which are suggestive of portal venous air. CT scans confirmed the finding and revealed the cause (see the 2 Images that follow). |
 | Media file 17: Mesenteric ischemia. CT scan in an 83-year-old woman obtained after suggestive sonographic findings of portal venous air were observed confirms the presence of air in the portal-venous system and proximal small bowel mucosal edema. These findings suggest ischemia of the affected bowel. |
 | Media file 18: Mesenteric ischemia. CT scan in an 83-year-old woman obtained after suggestive sonographic findings of portal venous air were observed confirms the presence of air in the portal-venous system and proximal small-bowel mucosal edema. These findings suggest ischemia of the affected bowel. Whenever pneumatosis is found, one should search the mesenteric and portal veins for gas. |
More on Mesenteric Ischemia |
| Overview: Mesenteric Ischemia |
| Imaging: Mesenteric Ischemia |
| Follow-up: Mesenteric Ischemia |
 Multimedia: Mesenteric Ischemia |
| References |
| « Previous Page |
References
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Further Reading
Keywords
mesenteric ischemia, bowel infarction, bowel ischemia, intestinal angina, ischemic colitis, bowel necrosis, bowel ischemia
