A case report of segmental arterial mediolysis in

Authors: Haruka Yoshida Katsuaki Ukai Mikako Sugimura Hiromichi Akoshima Kenji Kimura Masahiro Iwabuchi Keiichi Tadokoro Hiroki Takahashi Hiroya Rikimaru Toshihiro Saitoh Hiroyoshi Suzuki

Publish Date: 2013/11/06

Volume: 6, Issue: 6, Pages: 447-453

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Abstract

A 48yearold male presented to our hospital with abdominal pain Laboratory studies showed no abnormality the severity of his abdominal pain decreased and the patient was discharged Five days later the patient visited a neighborhood clinic because of fever with a 3day history of temperatures of approximately 38 °C The patient was admitted to our hospital 6 days after his initial visit Laboratory investigation revealed a Creactive protein level of 182 mg/dL Abdominal computed tomography CT showed an 80 × 60 mm hematoma behind the descending colon but no extravasation was detected Thinslice maximumintensityprojection images from CT angiography CTA showed irregular narrowing and intermittent fusiform dilatations of the left colonic artery suggesting a vascular disease such as segmental arterial mediolysis SAM Digital subtraction angiography showed local irregularity and ‘beading and narrowing’ of the left colonic artery similar to the findings on CTA Left hemicolectomy was electively performed on the twentyfifth hospital day Histological findings were consistent with SAM Thus CTA was a useful modality for the early diagnosis of SAMIn 1976 Slavin et al 1 first described a distinct arterial lesion found in the large abdominal muscular arteries of 3 autopsied patients and called it ‘segmental mediolytic arteritis’ Its chief morphologic characteristic was medial disappearance through an apparent lytic process It was later revealed that the inflammatory response to this lesion was not uniform and was generally not distributed within the arterial wall Later the term ‘segmental arterial mediolysis SAM’ was coined 2 3 The most common presentations are abdominal pain and hemorrhage in the elderly Treatment options include conservative care surgical intervention and/or endovascular therapy 4 5 However the incidence and mortality of SAM is difficult to accurately estimate because of the rare nature of the disease 6 and optimal therapy for SAM has not been established Although histopathological examination is the gold standard for diagnosis patients do not always undergo surgery Digital subtraction angiography DSA is a useful substitute for histopathological diagnosis and can detect specific findings of SAM DSA features of SAM are arterial dilatations aneurysms and occlusions of visceral arteries 7 Moreover CT angiography CTA can substitute DSA as a noninvasive diagnostic method 8 We report a case of SAM resulting in an intraabdominal hematoma in which CTA was useful for the diagnosis

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