Clinically Suspected Segmental Arterial Mediolysis of the Splanchnic Arteries: A Report of 2 Rare Cases
Challenging differential diagnosis, Diagnostic / therapeutic accidents, Management of emergency care, Rare disease
Federica Castelli, Corrado Inì, Giovanni Scavone, Marco Zagarella, Giorgio Giulietti, Giuseppe Caltabiano, Marco Vittorio Pizzarelli, Bruno Varsallona, Antonio Scavone, Antonio Basile
Department of Diagnostic Radiology, Neuroradiology and Interventional Radiology, ARNAS ‘Garibaldi Centro’ Hospital, Catania, Italy
Am J Case Rep 2021; 22:e929013
Available online: 2021-02-25
Segmental arterial mediolysis (SAM) is an uncommon vascular pathology characterized by arteriopathy, mainly of medium-sized abdominal splanchnic vessels, without an atherosclerotic, inflammatory, infectious, or autoimmune underlying etiology. Segmental arterial mediolysis is clinically heterogeneous and symptoms may be completely nonspecific. The knowledge of radiological features of segmental arterial mediolysis and the exclusion of other pathologies should direct early diagnosis and refer patients for correct treatment.
CASE REPORT: In the last 2 years, we treated 2 different adult patients (an 89-year-old woman and a 52-year-old man) with spontaneous visceral bleeding, admitted to the Emergency Department due to acute onset of abdominal pain, anemia, and computed tomographic angiography (CTA) evidence of aneurysmatic, and stenotic alterations of splanchnic arteries. Based on clinical, laboratory, and radiological features, segmental arterial mediolysis was suspected. These 2 patients were referred to our Interventional Radiology Department and treated with super-selective transcatheter arterial embolization (TAE), performed by a minimally invasive approach, allowing an immediate clinical improvement with regression of symptoms and avoiding major surgical treatment.
CONCLUSIONS: In patients with clinical, laboratory, and radiological signs of acute and/or chronic abdominal bleeding and radiological findings suggesting segmental arterial mediolysis, mini-invasive endovascular treatment is a safe, extremely reliable, and secure procedure and appears to be the first-choice treatment when available. Since abdominal bleeding could have fatal consequences in these patients, timely diagnosis and endovascular therapy are essential to treat visceral vascular alterations due to segmental arterial mediolysis.
Keywords: Aneurysm, False, Angiography, Digital Subtraction, Embolization, Therapeutic, Radiology, Interventional, Tomography Scanners, X-Ray Computed