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Updated: May 26, 2026

Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
[Acute mesenteric ischemia: Value of cross-sectional imaging]
E Delhom1, S Aufort, V Shrembi
1Service d'imagerie médicale, CHU Saint-Eloi, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France. e-delhom@chu-montpellier.fr
Abstract:
Acute mesenteric ischemia (AMI) is a life-threatening emergency with prognosis directly correlated with the delay in diagnosis and treatment. Clinical and laboratory findings are nonspecific and it is imperative to look for findings of AMI on CT and ultrasound examinations performed in patients with acute abdomen. Arterial and venous ischemia are different entities with different clinical and imaging features, treatment and prognosis. The main causes of AMI are arterial thromboembolic disease and low-flow state. Venous ischemia is less frequent. Due to its high reported sensitivity (90%), CT should be performed as a firstline imaging modality when AMI is suspected. CT and ultrasound imaging features of AMI include: bowel wall thickness and enhancement abnormalities, pneumatosis, portal venous gas, demonstration of intravascular thrombus, bowel dilatation and ascitis.
Insights
Acute mesenteric ischemia (AMI) requires prompt diagnosis. CT scans are crucial for identifying AMI, showing specific imaging features like bowel wall changes and gas within vessels.
Area of Science:
- Radiology
- Gastroenterology
- Emergency Medicine
Background:
- Acute mesenteric ischemia (AMI) is a critical surgical emergency.
- Delayed diagnosis and treatment significantly worsen patient prognosis.
- Clinical and laboratory findings for AMI are often nonspecific.
Purpose of the Study:
- To highlight the importance of imaging in diagnosing AMI.
- To differentiate between arterial and venous mesenteric ischemia.
- To outline key CT and ultrasound findings indicative of AMI.
Main Methods:
- Review of CT and ultrasound imaging features in patients with acute abdomen.
- Emphasis on CT as a first-line modality due to high sensitivity (90%).
- Discussion of distinct imaging characteristics for arterial vs. venous ischemia.
Main Results:
- CT and ultrasound reveal specific signs of AMI.
- Key findings include bowel wall thickening/enhancement abnormalities, pneumatosis, and portal venous gas.
- Intravascular thrombus, bowel dilatation, and ascites are also significant indicators.
Conclusions:
- Imaging, particularly CT, is imperative for timely AMI diagnosis.
- Recognizing specific imaging features aids in differentiating arterial and venous ischemia.
- Prompt identification through imaging improves patient outcomes for acute mesenteric ischemia.
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