Ultrasound Pictures of “Mesenteric Vascular Occlusion”

Clinical manifestations: Colicky pain of very sudden onset, circumscribed and
later diffuse. The pain subsides as the condition worsens. Intestinal gangrene
develops with peritonitis and abdominal rigidity, sepsis, and shock. Vomiting,
nausea, diarrhea, and constipation may occur.

Cause is often cardiogenic: Absolute arrhythmia with atrial fibrillation, dilatative
cardiomyopathy, or a ventricular aneurysm after myocardial infarction

Course: Embolism develops more rapidly than thrombosis

Diagnosis:
x Laboratory findings: Include acidosis, elevated serum lactate, and leukocytosis
x Ultrasound imaging and Doppler sonography of the mesenteric vessels (superior and inferior mesenteric arteries)
x Radiography: Contrast enema with a water-soluble contrast medium to check
for edematous thickening (“thumbprinting”) of the bowel wall
x Celiacography and mesentericography
x Look for the source of the embolus and/or signs of atherosclerosis.

Sonographic findings:
x Significant, hypoechoic wall thickening affecting a long bowel segment, becoming less pronounced over time.

x Acute luminal narrowing, progressing to dilatation due to ischemic malabsorption
x Decreased peristalsis progressing to aperistalsis
x Doppler sonography: atherosclerosis of the mesenteric vessels, occasionally
with demonstrable stenosis of the celiac trunk or superior mesenteric artery

Accuracy of ultrasound diagnosis: Typical ultrasound findings narrow the differential diagnosis, but mesenteric vascular occlusion cannot be diagnosed by exclusion. The definitive diagnosis is made at operation, since an arterial stenotic occlusion and a thrombotic venous occlusion are often indistinguishable by ultrasound.

Ultrasound Pictures of Mesenteric infarction: Segmental thickening of hypoechoic bowel wall (BW) with absence of peristalsis. The bowel lumen appears as an echogenic band

Ultrasound Pictures of Acute portal vein thrombosis. Mass in the portal vein (VP) is isoechoic to liver tissue (arrows). Doppler scanning shows no evidence of flow

Ultrasound Pictures of a and c a Stenosis of the superior mesenteric artery: Echogenic plaques at the origin of the superior mesenteric artery, initially difficult to identify. b CDS shows bright color pixels (aliasing) indicating turbulence and high flow velocities. c Spectral curve in a pulsed Doppler scan shows flow acceleration to 4 m/s