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Segmental arterial mediolysis mimics systemic vasculitis.

Melike Kalfa1, Hayriye Kocanaoğulları1, Gonca Karabulut1

  • 1Department of Internal Medicine, Division of Rheumatology, Ege University School of Medicine, İzmir, Turkey.

European Journal of Rheumatology
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Summary

Segmental arterial mediolysis (SAM) is a rare vascular condition affecting abdominal arteries, often causing internal bleeding. This case highlights the challenges in diagnosing and treating SAM, emphasizing its potential for fatal outcomes.

Keywords:
Pseudoaneurysmsegmental arterial mediolysisvasculitis

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Area of Science:

  • Vascular Medicine
  • Radiology
  • Pathology

Background:

  • Segmental arterial mediolysis (SAM) is a rare, nonarteriosclerotic, noninflammatory vascular disease.
  • It primarily affects medium-to-large sized abdominal arteries.
  • SAM often presents with intra-abdominal hemorrhages.

Purpose of the Study:

  • To report a case of SAM affecting multiple abdominal arteries.
  • To discuss the diagnostic challenges and treatment of SAM.
  • To highlight the potential severity and mortality associated with SAM.

Main Methods:

  • Diagnosis of SAM was established by excluding other potential causes.
  • Transcatheter embolization was performed in two separate sessions.
  • The patient's clinical course and outcome were documented.

Main Results:

  • The patient presented with SAM affecting the celiac, right renal, superior mesenteric (jejunal branch), left gastric, and splenic arteries.
  • Despite transcatheter embolization, the patient's outcome was unfavorable, with death due to an undefined reason.
  • SAM was noted to mimic systemic vasculitis and cause abdominal pain.

Conclusions:

  • SAM is a critical vascular diagnosis to consider in patients with unexplained abdominal pain and hemorrhage.
  • Early recognition and appropriate management are crucial, although outcomes can be poor.
  • The condition poses a significant risk of mortality due to abdominal hemorrhage or arterial infarction.