Intestinal Ischemia Versus Intramural Hemorrhage: CT Evaluation

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Intestinal Ischemia Versus Intramural Hemorrhage: CT Evaluation

Michael Macari¹, Hersch Chandarana, Emil Balthazar and James Babb

^¹ All authors: Department of Radiology, Abdominal Imaging Section, Tisch Hospital, New York University Medical Center, 560 First Ave., Ste. HW 207, New York, NY 10016.

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Fig. 1A. —Diffuse small-bowel ischemia in 60-year-old man with occlusive mesenteric ischemia. Axial CT scan obtained with IV and oral contrast materials at level of superior mesenteric artery and vein shows diminutive caliber of artery (arrow) relative to vein.

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Fig. 1B. —Diffuse small-bowel ischemia in 60-year-old man with occlusive mesenteric ischemia. Axial CT scan obtained at level of inferior mesenteric artery (arrow) shows large caliber of this vessel. Long segment of small-bowel dilatation has minimal wall thickness of 1-2 mm.

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Fig. 1C. —Diffuse small-bowel ischemia in 60-year-old man with occlusive mesenteric ischemia. Lateral aortogram shows nonfilling of superior mesenteric artery (SMA), celiac axis, and large-caliber inferior mesenteric artery (IMA) (arrows). At surgery, patchy areas of necrosis were found in small bowel, requiring small-bowel resection.

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Fig. 2A. —80-year-old woman with a long segment of small-bowel infarction. Attenuation of involved small bowel was decreased relative to segments that are not involved. Axial CT scan obtained with IV contrast material at level of mid abdomen shows segment of small bowel (thin arrow) with lack of enhancement and thin wall. Other small-bowel loops (thick arrow) show enhancement and mild mural thickening of 2-3 mm. Patient refused surgical intervention.

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Fig. 2B. —80-year-old woman with a long segment of small-bowel infarction. Attenuation of involved small bowel was decreased relative to segments that are not involved. Axial CT scan obtained several days later shows intraperitoneal free air (arrow). Patient died several hours later, and autopsy revealed diffuse small-bowel infarction.

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Fig. 3A. —Segmental small-bowel ischemia in 40-year-old woman with thrombosis of superior mesenteric vein. Axial CT scan obtained with IV and oral contrast materials at level of superior mesenteric vein shows thrombus (arrow) within vein.

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Fig. 3B. —Segmental small-bowel ischemia in 40-year-old woman with thrombosis of superior mesenteric vein. Axial CT scan obtained several centimeters caudad to A shows homogeneous thickening (7 mm) (arrow) in loop of ileum.

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Fig. 3C. —Segmental small-bowel ischemia in 40-year-old woman with thrombosis of superior mesenteric vein. Axial CT scan several centimeters caudad to B shows continuous homogeneous thickening of ileum (right arrow) to level of terminal ileum (left arrow). Approximately 25-30 cm of small bowel was estimated to be involved. Patient was treated with anticoagulation therapy and did not require surgery.

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Fig. 4. —Nonocclusive mesenteric ischemia in 67-year-old man with cardiomyopathy. Axial CT scan obtained with IV and oral contrast materials at level of pelvis shows several small-bowel loops with mild (3-mm) mural thickening (arrow). Patient improved with conservative management.

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Fig. 5. —Intramural hemorrhage in 72-year-old man who had elevated international normalized ratio and who was taking anticoagulation medication. Axial CT scan obtained with IV and oral contrast materials at level of mid abdomen shows markedly thickened (16-mm) loop of small bowel (arrow).

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Fig. 6A. —65-year-old woman with ischemic heartdisease and long segment of involvement of nonocclusive mesenteric ischemia. Axial CT scan obtained with IV and oral contrast materials at level of pelvis shows multiple small-bowel loops with mild mural thickening of 4-5 mm (arrows).

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Fig. 6B. —65-year-old woman with ischemic heartdisease and long segment of involvement of nonocclusive mesenteric ischemia. Axial CT scan obtained several centimeters cephalad to A shows multiple abnormal small-bowel loops (arrow). Approximately 50 cm of small bowel showed mural thickening.

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Fig. 7A. —Short-segment intramural hemorrhage in 66-year-old man who had elevated international normalized ratio and who was taking anticoagulation medication. Axial CT scan obtained with IV and oral contrast materials at level of upper abdomen shows short segment with moderate mural thickening of 10-11 mm (arrows).

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Fig. 7B. —Short-segment intramural hemorrhage in 66-year-old man who had elevated international normalized ratio and who was taking anticoagulation medication. Spot radiograph from small-bowel series shows regular thickened folds in jejunum over short segment of approximately 10 cm (arrows).

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Fig. 8. —Hemoperitoneum in 47-year-old man with intramural hemorrhage. Patient was taking anticoagulation medication and had elevated international normalized ratio. Axial CT scan obtained with IV and oral contrast materials at level of jejunum shows abnormal mural thickening with target sign (thick arrow). Associated hemoperitoneum (thin arrow) is also seen.

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