Acute Mesenteric Ischemia: Imaging Findings and Mimics

Adrian Qingyu Xu, Ken Nakanote, Siddhi Hegde, Sarah Bastawrous, Alex Chan, Jennifer S. Weaver, Jonathan Revels, Sherry S. Wang

Research output: Contribution to journalArticlepeer-review

Abstract

Acute mesenteric ischemia is a rapidly life-threatening condition in which the radiologist may play a crucial role in early diagnosis and thus improve patient outcomes. Acute mesenteric ischemia can occur from arterial embolism or thrombosis, venous occlusive, or nonocclusive etiologies. Key findings for acute arterial occlusion include hypoenhancing bowel, which is usually not thickened or dilated. Venous occlusion often results in a hyperenhancing, thickened, and dilated bowel. Nonocclusive mesenteric ischemia should be considered in the appropriate clinical context, when there is no vascular occlusion on CT, and when there is involvement of watershed regions without specific vascular territory abnormalities. Venous congestion and increased vascular permeability can result in mesenteric edema and ascites; however, it is not predictive of mesenteric ischemia severity. Pneumatosis alone may not indicate presence of nonviable bowel; however, pneumatosis with portal venous gas or pneumoperitoneum has high sensitivity for nonviable bowel. Clinical history and laboratory results can often help differentiate between acute mesenteric ischemia and its mimics, such as inflammatory bowel disease, enteritis, and radiation injury.

Original languageEnglish (US)
Pages (from-to)1-7
Number of pages7
JournalContemporary Diagnostic Radiology
Volume47
Issue number3
DOIs
StatePublished - Jan 31 2024
Externally publishedYes

Keywords

  • Acute Mesenteric Ischemia
  • Nonocclusive Mesenteric Ischemia
  • Superior Mesenteric Artery (SMA) Embolism
  • Superior Mesenteric Artery (SMA) Thrombosis
  • Venous Thrombosis

ASJC Scopus subject areas

  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

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