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Spontaneous Isolated Dissection of the Celiac Artery: CT Findings in Adults

Nicholas D'Ambrosio1, Barak Friedman1, David Siegel1, Douglas Katz2, Amit Newatia1 and John Hines1

1 Department of Radiology, Long Island Jewish Medical Center, 270-05 76th Ave., New Hyde Park, NY 11040.
2 Department of Radiology, Winthrop-University Hospital, Mineola, NY.


Figure 1
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  		Fig. 1A —45-year-old man with abdominal pain. Axial contrast-enhanced CT scan through upper abdomen shows intimal flap (arrow) in celiac trunk. Finding is consistent with celiac artery dissection.

 

Figure 2
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  		Fig. 1B —45-year-old man with abdominal pain. Coronal reformatted CT scan shows celiac artery dissection (arrow) and normal caliber, widely patent superior mesenteric artery (chevron) below it.

 

Figure 3
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  		Fig. 1C —45-year-old man with abdominal pain. Lateral projection from selective celiac angiogram 7 days after A shows irregular filling defect (arrow) corresponding to thrombosed false lumen not seen on initial CT.

 

Figure 4
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  		Fig. 2A —56-year-old man with bilateral lower-quadrant pain. Initial diagnosis was uncomplicated isolated celiac artery dissection. Follow-up CT scan 5 days after initial diagnosis shows extension of dissection from celiac trunk into proximal hepatic artery (arrow).

 

Figure 5
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  		Fig. 2B —56-year-old man with bilateral lower-quadrant pain. Initial diagnosis was uncomplicated isolated celiac artery dissection. Axial maximum-intensity-projection image shows extension of dissection from celiac trunk into proximal hepatic artery, which is markedly attenuated by thrombosed false lumen (star).

 

Figure 6
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  		Fig. 3A —45-year-old man with vague abdominal pain and isolated celiac artery dissection. Coronal oblique CT multiplanar reformatted image 6 days after initial study shows extension of dissection into proximal splenic artery (arrow).

 

Figure 7
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  		Fig. 3B —45-year-old man with vague abdominal pain and isolated celiac artery dissection. Axial CT image from same examination as A shows splenic infarct (chevron) due to dissection into proximal splenic artery (arrow).

 

Figure 8
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  		Fig. 4A —56-year-old man with initial diagnosis of isolated celiac artery dissection. Initial CT showed normal homogeneous enhancement of both kidneys. CT scan obtained 5 days after initial CT examination shows new distal left renal artery dissection (arrow).

 

Figure 9
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  		Fig. 4B —56-year-old man with initial diagnosis of isolated celiac artery dissection. Initial CT showed normal homogeneous enhancement of both kidneys. CT scan from same examination as A shows renal infarct (arrow). Normal widely patent aorta shows no evidence of dissection or thrombus.

 

Figure 10
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  		Fig. 5 —56-year-old man with initial diagnosis of isolated celiac dissection without evidence of extension into adjacent vessels. Axial contrast-enhanced CT scan shows 1-cm aneurysm (arrow) of left hepatic artery not found on initial CT scans 2 months earlier.

 

Figure 11
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  		Fig. 6A —56-year-old man with abdominal pain. Initial unenhanced CT scan obtained to rule out renal stone shows nonspecific infiltration of fat (arrows) around celiac axis.

 

Figure 12
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  		Fig. 6B —56-year-old man with abdominal pain. Contrast-enhanced CT performed day after A shows intimal flap with associated thrombus (arrow) involving false lumen.

 

Figure 13
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  		Fig. 7A —56-year-old man with patellar fracture and syncope followed by back and abdominal pain. Contrast-enhanced axial CT pulmonary angiogram shows focal celiac artery dissection and associated celiac artery aneurysm measuring 1.4 cm.

 

Figure 14
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  		Fig. 7B —56-year-old man with patellar fracture and syncope followed by back and abdominal pain. Three-dimensional volume-rendered reformatted image shows narrowing of proximal celiac trunk (arrow), which represents true lumen.

 

Figure 15
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  		Fig. 7C —56-year-old man with patellar fracture and syncope followed by back and abdominal pain. Oblique 3D volume rendering shows associated celiac artery aneurysm.

 

Figure 16
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  		Fig. 8A —89-year-old man with abdominal pain and lower gastrointestinal bleeding. Contrast-enhanced axial (A) and sagittal reformatted (B) CT images show celiac artery aneurysm (arrow) measuring 1.5 cm. Portion of intimal flap of celiac dissection is evident immediately proximal to aneurysm in celiac trunk.

 

Figure 17
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  		Fig. 8B —89-year-old man with abdominal pain and lower gastrointestinal bleeding. Contrast-enhanced axial (A) and sagittal reformatted (B) CT images show celiac artery aneurysm (arrow) measuring 1.5 cm. Portion of intimal flap of celiac dissection is evident immediately proximal to aneurysm in celiac trunk.

 

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