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Updated: May 18, 2026
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Isolated celiac and superior mesenteric artery dissection identified with MDCT: imaging findings and clinical course
Franco Verde1, Karen B Bleich, Alexander Oshmyansky
1Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD 21287, USA. FV fverde1@jhmi.edu
Objective:
Isolated celiac or superior mesenteric artery (SMA) dissection is a rare entity in the absence of aortic dissection. Our objective was to detail imaging and clinical course of celiac and or SMA dissections.
Methods:
We conducted a retrospective search from 2004 to 2010 using "celiac and/or SMA dissection" keywords. Analysis of medical record and imaging at diagnosis and follow-up was performed. Dissections for any reason without aortic dissection were included.
Results:
Twenty-four celiac and 18 SMA dissections were detected in 38 patients. One third of the dissections diagnosed with interactive multiplanar reconstruction/maximum intensity projection (MIP)/3-dimensional (3D) rendering were missed on standard imaging planes. No patients had bowel ischemia or died. Eighty-four percent of the patients were observed, 2 patients received anticoagulation, 2 patients received surgical repair, and 3 patients received stenting. Twenty-three of 25 cases treated with observation exhibited no change or improvement/resolution (2/25) with 20.9-month mean follow-up.
Conclusion:
Most isolated celiac and SMA dissections were asymptomatic/incidental, supporting observation and surveillance with intervention reserved for vascular compromise. Interactive multiplanar reconstruction/maximum intensity projection/3D rendering can increase diagnostic sensitivity.
Insights
Isolated celiac and superior mesenteric artery (SMA) dissections are rare but often asymptomatic. Advanced imaging improves detection, and most cases can be managed with observation, reserving intervention for vascular compromise.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
- Gastroenterology
Background:
- Isolated celiac artery (CA) and superior mesenteric artery (SMA) dissections are uncommon conditions.
- These dissections typically occur without associated aortic dissection.
Purpose of the Study:
- To describe the imaging findings and clinical outcomes of isolated CA and SMA dissections.
- To evaluate the diagnostic utility of advanced imaging techniques.
Main Methods:
- Retrospective analysis of medical records and imaging from 2004 to 2010.
- Inclusion of dissections of the CA and/or SMA without concurrent aortic dissection.
- Utilized standard imaging planes and advanced techniques like multiplanar reconstruction (MPR), maximum intensity projection (MIP), and 3D rendering.
Main Results:
- Identified 24 CA dissections and 18 SMA dissections in 38 patients.
- Advanced imaging (MPR/MIP/3D) detected one-third of dissections missed on standard views.
- No patients experienced bowel ischemia or mortality; 84% were managed conservatively with observation.
Conclusions:
- Isolated CA and SMA dissections are frequently asymptomatic or incidental findings.
- Observation and surveillance are appropriate management strategies, with intervention reserved for cases of vascular compromise.
- Interactive MPR/MIP/3D rendering enhances diagnostic sensitivity for these rare dissections.
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