Segmental arterial mediolysis: a vasculitis mimicker. A single centre experience

Area of Science:

• Vascular Medicine
• Radiology
• Rare Diseases

Background:

• Segmental arterial mediolysis (SAM) is a rare, non-atherosclerotic, non-inflammatory arteriopathy affecting medium to large vessels.
• SAM can mimic vasculitis, necessitating careful diagnosis to guide appropriate management and avoid unnecessary immunosuppression.

Purpose of the Study:

• To describe the clinical presentation, diagnostic methods, and treatment outcomes of Segmental arterial mediolysis (SAM).
• To highlight the importance of recognizing SAM to differentiate it from vasculitis.

Main Methods:

• A single-center review of 6 consecutive SAM cases.
• A comprehensive literature search of 160 additional reported SAM cases.
• Diagnosis primarily utilized CT angiography (CTA).

Main Results:

• Abdominal or flank pain was the predominant presenting symptom in most cases.
• CT angiography (CTA) was the preferred diagnostic modality.
• Treatments included therapeutic angiography (embolization, stenting), anti-platelet therapy, and antihypertensive management.

Conclusions:

• Segmental arterial mediolysis (SAM) should be suspected in patients with abdominal or flank pain.
• Radiologists must carefully analyze angiographic features to distinguish SAM from vasculitis.