EURORAD ESR

Case 8719

Fatal ischemic small bowel infarction in anti-phospholipid syndrome

Author(s)
Mantarro A, Bemi P, Sighieri E, Vagli P, Vannucci S, Faggioni L, Neri E, Bargellini I, Cioni R, Bartolozzi C.
 
Patient
female, 52 year(s)
 
 
  • Figure 1
    Abdominal ultrasound examination

    Minimal perihepatic fluid accumulation.

     
    Area of Interest: Abdomen; Liver; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure;
     
     
  • Figure 2
    Plain abdominal RX
     

    The supine view (a) displays gastric and small bowel distension, while the colonic frame is gasless.

     
    Area of Interest: Abdomen; Gastrointestinal tract; Small bowel; Imaging Technique: Conventional radiography; Plain radiographic studies; Procedure: Diagnostic procedure;

    Tangential projection (b): evident gas-fluid levels in the small bowel area, no signs of pneumoperitoneum.

     
    Area of Interest: Abdomen; Gastrointestinal tract; Small bowel; Imaging Technique: Conventional radiography; Plain radiographic studies; Procedure: Diagnostic procedure;
     
     
  • Figure 3
    Initial CT evaluation
     

    Minimal perihepatic and perisplenic fluid accumulations.

     
    Area of Interest: Abdomen; Liver; Spleen; Imaging Technique: CT-High Resolution; Procedure: Contrast agent-intravenous; Diagnostic procedure;

    Minimal perihepatic and perisplenic fluid accumulations.

     
    Area of Interest: Abdomen; Liver; Spleen; Imaging Technique: CT-High Resolution; Procedure: Contrast agent-intravenous; Diagnostic procedure;

    Minimal perihepatic and perisplenic fluid accumulations.

     
    Area of Interest: Abdomen; Liver; Spleen; Imaging Technique: CT-High Resolution; Procedure: Contrast agent-intravenous; Diagnostic procedure;

    Diffuse fluid distension of small bowel loops with multiple gas-fluid levels.

     
    Area of Interest: Abdomen; Gastrointestinal tract; Small bowel; Imaging Technique: CT-High Resolution; Procedure: Contrast agent-intravenous; Diagnostic procedure;

    Regular thickening and contrast enhancement of bowel walls.

     
    Area of Interest: Abdomen; Gastrointestinal tract; Small bowel; Imaging Technique: CT-High Resolution; Procedure: Contrast agent-intravenous; Diagnostic procedure;

    Accentuation of the median abdominal wall hernia.

     
    Area of Interest: Abdomen; Gastrointestinal tract; Imaging Technique: CT-High Resolution; Procedure: Contrast agent-intravenous; Diagnostic procedure;

    Coronal MPR reconstruction confirms diffuse fluid distension of small bowel loops with multiple gas-fluid levels.

     
    Area of Interest: Abdomen; Gastrointestinal tract; Small bowel; Imaging Technique: CT-High Resolution; Image manipulation / Reconstruction; Procedure: Contrast agent-intravenous; Diagnostic procedure;

    Sagittal MPR reconstruction documents the obstruction of aorto-superior mesenteric bypass.

     
    Area of Interest: Abdomen; Gastrointestinal tract; Vascular; Imaging Technique: CT-High Resolution; Procedure: Contrast agent-intravenous;

    MPR reconstruction shows distal revascularization by collateral vessels stemming from the gastroduodenal artery, indicating a chronic occlusion of aorto-superior mesenteric bypass.

     
    Area of Interest: Abdomen; Gastrointestinal tract; Vascular; Imaging Technique: CT-High Resolution; Image manipulation / Reconstruction; Procedure: Contrast agent-intravenous; Diagnostic procedure;

    MPR reconstruction shows distal revascularization by collateral vessels stemming from the gastroduodenal artery, indicating a chronic occlusion of aorto-superior mesenteric bypass.

     
    Area of Interest: Abdomen; Gastrointestinal tract; Vascular; Imaging Technique: Image manipulation / Reconstruction; Procedure: Contrast agent-intravenous;
     
     
  • Figure 4
    Second CT evaluation (one week later)
     

    Inhomogeneous liver parenchyma; inhomogeneous hypodense area located just below the diaphragm and characterized by indistinct margins and dilatation of intrahepatic bile-ducts, suggestive of hepatic abscess.

     
    Area of Interest: Abdomen; Liver; Imaging Technique: CT-High Resolution; Procedure: Contrast agent-intravenous; Diagnostic procedure;

    Inhomogeneous liver parenchyma; inhomogeneous hypodense area located just below the diaphragm and characterized by indistinct margins and dilatation of intrahepatic bile-ducts, suggestive of hepatic abscess.

     
    Area of Interest: Abdomen; Liver; Imaging Technique: CT-High Resolution; Procedure: Contrast agent-intravenous; Diagnostic procedure;

    Inhomogeneous liver parenchyma.

     
    Area of Interest: Abdomen; Liver; Imaging Technique: CT-High Resolution; Procedure: Contrast agent-intravenous; Diagnostic procedure;

    Lung window setting: consolidation area within the lower lobe of right lung in association with scissural thickening.

     
    Area of Interest: Lung; Respiratory system; Thorax; Imaging Technique: CT-High Resolution; Procedure: Contrast agent-intravenous; Diagnostic procedure;
     
     
Minimal perihepatic fluid accumulation.
 
The supine view (a) displays gastric and small bowel distension, while the colonic frame is gasless.
 
Tangential projection (b): evident gas-fluid levels in the small bowel area, no signs of pneumoperitoneum.
 
Minimal perihepatic and perisplenic fluid accumulations.
 
Minimal perihepatic and perisplenic fluid accumulations.
 
Minimal perihepatic and perisplenic fluid accumulations.
 
Diffuse fluid distension of small bowel loops with multiple gas-fluid levels.
 
Regular thickening and contrast enhancement of bowel walls.
 
Accentuation of the median abdominal wall hernia.
 
Coronal MPR reconstruction confirms diffuse fluid distension of small bowel loops with multiple gas-fluid levels.
 
Sagittal MPR reconstruction documents the obstruction of aorto-superior mesenteric bypass.
 
MPR reconstruction shows distal revascularization by collateral vessels stemming from the gastroduodenal artery, indicating a chronic occlusion of aorto-superior mesenteric bypass.
 
MPR reconstruction shows distal revascularization by collateral vessels stemming from the gastroduodenal artery, indicating a chronic occlusion of aorto-superior mesenteric bypass.
 
Inhomogeneous liver parenchyma; inhomogeneous hypodense area located just below the diaphragm and characterized by indistinct margins and dilatation of intrahepatic bile-ducts, suggestive of hepatic abscess.
 
Inhomogeneous liver parenchyma; inhomogeneous hypodense area located just below the diaphragm and characterized by indistinct margins and dilatation of intrahepatic bile-ducts, suggestive of hepatic abscess.
 
Inhomogeneous liver parenchyma.
 
Lung window setting: consolidation area within the lower lobe of right lung in association with scissural thickening.
 
 
 
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