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Segmental Arterial Mediolysis: CTA Findings at Presentation and Follow-Up

Maren Michael1, Urs Widmer2, Simon Wildermuth1, Andre Barghorn3, Stefan Duewell4 and Thomas Pfammatter1

1 Institute of Diagnostic Radiology, University Hospital of Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland.
2 Department of Medicine, University Hospital of Zurich, Zurich, Switzerland.
3 Department of Pathology, University Hospital of Zurich, Zurich, Switzerland.
4 Institute of Radiology, Kantonsspital, Frauenfeld, Switzerland.


Figure 1
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  		Fig. 1A —75-year-old man with segmental arterial mediolysis (case 1). Contrast-enhanced CT image shows mesenteric hematoma (arrows).

 

Figure 2
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  		Fig. 1B —75-year-old man with segmental arterial mediolysis (case 1). Digital subtraction angiography (DSA) image of superior mesenteric artery shows typical string-of-beads appearance and small aneurysms of middle colic artery (arrow).

 

Figure 3
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  		Fig. 1C —75-year-old man with segmental arterial mediolysis (case 1). DSA image of same artery 4 years later shows normal artery.

 

Figure 4
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  		Fig. 2A —46-year-old man with segmental arterial mediolysis (case 2). Contrast-enhanced axial CT image shows aneurysm of celiac trunk (arrow) (2 cm in diameter) and proper hepatic artery (3.5 cm in diameter) (arrowhead). In addition, there is segmental kidney infarction.

 

Figure 5
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  		Fig. 2B —46-year-old man with segmental arterial mediolysis (case 2). Thin-slice maximum-intensity-projection image from CT angiography at 3-year follow-up shows that aneurysm of proper hepatic artery was successfully obliterated after coil embolization. Size of aneurysm of celiac trunk is unchanged.

 

Figure 6
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  		Fig. 3A —73-year-old man with segmental arterial mediolysis (case 3). Surface shaded display 3D reconstruction image from CT angiography of superior mesenteric artery (SMA) shows small aneurysm of middle colic artery (arrowhead) and caliber irregularities of SMA (arrows).

 

Figure 7
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  		Fig. 3B —73-year-old man with segmental arterial mediolysis (case 3). Digital subtraction angiography image shows aneurysm of middle colic artery (arrowhead), string-of-beads appearance of SMA (small arrows), and small aneurysm of gastroduodenal artery (large arrow).

 

Figure 8
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  		Fig. 3C —73-year-old man with segmental arterial mediolysis (case 3). At follow-up 3 years after diagnosis and hemicolectomy (including resection of middle colic artery aneurysm), surface shaded display 3D reconstruction image from CT angiography shows persisting string-of-beads appearance of SMA (small arrows) and small aneurysm of gastroduodenal artery (large arrow).

 

Figure 9
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  		Fig. 4 —57-year-old woman with segmental arterial mediolysis (case 4). Gross postmortem specimen of abdominal aorta shows superior and inferior mesenteric artery. Note tubular ectasia of middle colic artery and Riolan's arch (arrowheads).

 

Figure 10
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  		Fig. 5A —46-year-old man with segmental arterial mediolysis (case 5). Digital subtraction angiography (A) and surface shaded display 3D reconstruction image of CT angiography (B) of superior mesenteric artery (SMA) show occlusion of middle colic artery and several jejunal branches. One jejunal branch has tubular aneurysm (arrow).

 

Figure 11
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  		Fig. 5B —46-year-old man with segmental arterial mediolysis (case 5). Digital subtraction angiography (A) and surface shaded display 3D reconstruction image of CT angiography (B) of superior mesenteric artery (SMA) show occlusion of middle colic artery and several jejunal branches. One jejunal branch has tubular aneurysm (arrow).

 

Figure 12
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  		Fig. 5C —46-year-old man with segmental arterial mediolysis (case 5). Thin-slice maximum-intensity-projection image from CT angiography at follow-up 9 months after diagnosis shows regression of tubular aneurysm of jejunal branch (arrow) and only slight caliber irregularities of SMA.

 

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