Acute Mesenteric Ischemia: Imaging Findings and Mimics

IF 0.1 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Adrian QingYu Xu, Ken Nakanote, Siddhi Hegde, Sarah Bastawrous, Alex Chan, Jennifer S. Weaver, Jonathan Revels, Sherry S. Wang
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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.
急性肠系膜缺血:成像检查结果和模拟病例
急性肠系膜缺血是一种迅速危及生命的疾病,放射科医生可在早期诊断中发挥关键作用,从而改善患者的预后。急性肠系膜缺血可由动脉栓塞或血栓形成、静脉闭塞或非闭塞性病因引起。急性动脉闭塞的主要检查结果包括肠管强化不足,通常不会增厚或扩张。静脉闭塞通常会导致肠道过度强化、增厚和扩张。非闭塞性肠系膜缺血应在适当的临床情况下考虑,即 CT 上无血管闭塞,以及分水岭区域受累但无特定血管区域异常时。静脉充血和血管通透性增加可导致肠系膜水肿和腹水,但并不能预测肠系膜缺血的严重程度。单纯的气胸可能并不能说明肠管已坏死,但气胸伴门静脉积气或腹腔积气对肠管坏死的敏感性很高。临床病史和实验室结果通常有助于区分急性肠系膜缺血和其模拟病,如炎症性肠病、肠炎和放射性损伤。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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