Chronic mesenteric ischemia occurs because of occlusive or stenotic atherosclerotic disease and most commonly involves at least 2 or 3 main vessels. It is more prevalent in the elderly population and in patients with major risk factors for atherosclerosis, such as hypertension, hyperlipidemia, and smoking history [12]. Discussion of Procedures by Variant Variant 1: Suspected acute mesenteric ischemia. Initial Imaging. Patients with acute mesenteric ischemia present with abdominal pain out of proportion to the physical examination [2]. A high index of suspicion is necessary to achieve early diagnosis, particularly in the elderly or hospitalized patient population [13,14]. The main challenge is to differentiate acute mesenteric ischemia from Reprint requests to: publications@acr.org Imaging of Mesenteric Ischemia other more common causes of acute abdominal pain, such as appendicitis, diverticulitis, peptic ulcer disease, acute pancreatitis, gastroenterocolitis, nephrolithiasis, cholelithiasis, and cholecystitis. Early in the course of disease, laboratory findings are of little value in differentiating among these causes, with the results usually demonstrating metabolic acidosis, elevated lactate and D-dimer, leukocytosis, hemoconcentration, elevated amylase levels, and/or abnormal liver enzymes [15,16]. Unfortunately, the signs, symptoms, and laboratory testing are insufficient for making the diagnosis [15]. Radiography Abdomen Radiography has historically been considered the first imaging modality in the evaluation of acute abdominal pain, but because of its low diagnostic yield and generally nonspecific findings, its role has been debated in current practice [17]. Abdominal radiography does not exclude the diagnosis of acute mesenteric ischemia as 25% of patients with this condition will have normal radiographs [18].
Imaging of Mesenteric Ischemia. Chronic mesenteric ischemia occurs because of occlusive or stenotic atherosclerotic disease and most commonly involves at least 2 or 3 main vessels. It is more prevalent in the elderly population and in patients with major risk factors for atherosclerosis, such as hypertension, hyperlipidemia, and smoking history [12]. Discussion of Procedures by Variant Variant 1: Suspected acute mesenteric ischemia. Initial Imaging. Patients with acute mesenteric ischemia present with abdominal pain out of proportion to the physical examination [2]. A high index of suspicion is necessary to achieve early diagnosis, particularly in the elderly or hospitalized patient population [13,14]. The main challenge is to differentiate acute mesenteric ischemia from Reprint requests to: publications@acr.org Imaging of Mesenteric Ischemia other more common causes of acute abdominal pain, such as appendicitis, diverticulitis, peptic ulcer disease, acute pancreatitis, gastroenterocolitis, nephrolithiasis, cholelithiasis, and cholecystitis. Early in the course of disease, laboratory findings are of little value in differentiating among these causes, with the results usually demonstrating metabolic acidosis, elevated lactate and D-dimer, leukocytosis, hemoconcentration, elevated amylase levels, and/or abnormal liver enzymes [15,16]. Unfortunately, the signs, symptoms, and laboratory testing are insufficient for making the diagnosis [15]. Radiography Abdomen Radiography has historically been considered the first imaging modality in the evaluation of acute abdominal pain, but because of its low diagnostic yield and generally nonspecific findings, its role has been debated in current practice [17]. Abdominal radiography does not exclude the diagnosis of acute mesenteric ischemia as 25% of patients with this condition will have normal radiographs [18].