Pitfall of isolated superior mesenteric artery dissection with normal D-dimer level

Area of Science:

• Vascular Surgery
• Diagnostic Imaging
• Emergency Medicine

Background:

• Untreated hypertension is a significant risk factor for vascular emergencies.
• Sudden-onset abdominal pain can present with diverse etiologies, complicating diagnosis.
• D-dimer testing is commonly used to rule out thromboembolic events.

Observation:

• A 51-year-old male presented with acute epigastric pain.
• The patient had a history of untreated hypertension.
• Initial laboratory results included a normal D-dimer level.

Findings:

• Abdominal contrast-enhanced computed tomography (CECT) identified superior mesenteric artery dissection.
• This diagnosis was made despite the normal D-dimer, highlighting limitations of this biomarker.
• CECT is essential for visualizing mesenteric artery pathology.

Implications:

• Superior mesenteric artery dissection should be considered in patients with sudden abdominal pain, particularly those with hypertension.
• Diagnostic imaging, such as CECT, is critical for accurate and timely diagnosis of mesenteric artery dissection.
• Clinical suspicion and appropriate imaging can overcome reliance on potentially misleading laboratory markers like D-dimer.