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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2021; 31(04): 983-989
DOI: 10.1055/s-0041-1736583
Case Series

Clinical Presentation, Imaging, and Management of Segmental Arterial Mediolysis: A Rare Vascular Disorder

Ezhilmathi Alavandar
1   Department of Radiology, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
,
Shobana Umapathy
1   Department of Radiology, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
,
Santhosh Poyyamoli
1   Department of Radiology, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
,
Venkatesh Kasi Arunachalam
1   Department of Radiology, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
,
Pankaj Mehta
1   Department of Radiology, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
,
Mathew Cherian
1   Department of Radiology, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
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Abstract

Objectives Our objective was to analyze the clinical presentation, imaging findings, and the management of segmental arterial mediolysis (SAM) in different case scenarios within our medical institution.

Materials and Methods We retrospectively analyzed 13 cases of SAM in our institution from July 2017 to March 2020. The images from the cases were collected from picture archiving and communication system (PACS) along with other pertinent clinical information from the hospital's information system. All the patients we studied underwent contrast-enhanced computed tomography (CT) using a third-generation Siemens SOMATOM Force dual-source CT scanner. Once the dual-phase scanning was completed, the images were analyzed using the workstation's syngo.via software.

Results Three out of the 13 cases required stent-grafting of the renal/celiac artery, and the involved branch of the superior mesenteric artery was embolized in one case. The rest of the cases were managed conservatively with antiplatelets/anticoagulants. Subsequent follow-ups of the patients were conducted and showed stabilization/regression of the initial findings without finding any evidence of worsening.

Conclusion SAM should be considered when making a differential diagnosis of acute abdominal pain when associated with dissection or aneurysms in splanchnic arteries, and in cases of unexplained intra-abdominal hemorrhaging. The radiologist needs to be aware of this possibility to raise suspicion, alert the clinician, and guide appropriate management.

Keywords

dissection - embolization - hemorrhage - management - segmental arterial mediolysis

Source of Support (If present, give more details)

Nil.


Presentation at a Meeting

Nil.




Publication History

Article published online:
30 November 2021

© 2021. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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