Unsuspected Mesenteric Arterial Abnormality: Comparison of MDCT Axial Sections to Interactive 3D Rendering
Jennifer K. Chen1,
Pamela T. Johnson1,2,
Karen M. Horton1,2 and
Elliot K. Fishman1,2
1 The Johns Hopkins University School of Medicine, Baltimore, MD 21287.
2 Department of Radiology, Johns Hopkins School of Medicine, 601 N Caroline St.,
Room 3251, Baltimore, MD 21287.
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Fig. 1A —78-year-old man with history of infrarenal abdominal aortic
aneurysm. Axial CT image through celiac axis shows narrowing of proximal
celiac axis (arrow). This finding was not described on axial
report.
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Fig. 1B —78-year-old man with history of infrarenal abdominal aortic
aneurysm. Axial CT image at origin of superior mesenteric artery (SMA) shows
narrowing of SMA (arrow). This finding was not described on axial
report.
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Fig. 1C —78-year-old man with history of infrarenal abdominal aortic
aneurysm. Sagittal maximum-intensity-projection 3D CT angiogram shows moderate
stenosis of proximal celiac axis (arrow) with poststenotic dilatation
and stenosis of proximal SMA (arrowhead). These findings were both
described on 3D report. Follow-up CT described celiac stenosis only. Abdominal
aortic aneurysm is also seen.
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Fig. 2 —78-year-old woman with clinical suspicion for pancreatic
mass. Sagittal volume-rendered image shows two focal areas of stenosis
(arrows) involving celiac axis. More proximal stenosis (black
arrow) has hooked appearance that is typical for median arcuate ligament
syndrome; this was confirmed on MRI. No abnormalities were described on axial
report.
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Fig. 3A —41-year-old woman who underwent CT for evaluation as
potential renal donor. Axial CT image at level of renal arteries shows
significant narrowing of space (arrow) between superior mesenteric
artery (SMA) and aorta. This was not noted on axial report.
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Fig. 3B —41-year-old woman who underwent CT for evaluation as
potential renal donor. Axial CT image slightly inferior in relation to
A shows that left renal vein (arrows) is compressed by SMA.
This was not noted on axial report.
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Fig. 3C —41-year-old woman who underwent CT for evaluation as
potential renal donor. Axial CT image through third portion of duodenum
(arrows) shows compression (arrowheads) of duodenum by SMA.
This was not noted on axial report.
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Fig. 3D —41-year-old woman who underwent CT for evaluation as
potential renal donor. Sagittal volume-rendered 3D CT angiogram confirms
decreased space between SMA and aorta. Notice narrow angle at takeoff of SMA.
These findings were described in 3D report, which suggested that this could be
SMA syndrome in proper clinical setting. Clinical findings supported
diagnosis.
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Fig. 4A —46-year-old woman with history of endovascular repair of
abdominal aortic aneurysm. Sagittal volume-rendered 3D CT (B) shows
celiac artery aneurysm, which was described on 3D report but not recognized on
axial section (A).
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Fig. 4B —46-year-old woman with history of endovascular repair of
abdominal aortic aneurysm. Sagittal volume-rendered 3D CT (B) shows
celiac artery aneurysm, which was described on 3D report but not recognized on
axial section (A).
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Fig. 5A —65-year-old man with clinical suspicion for pancreatic mass.
Patient also had undergone left nephrectomy for renal cell carcinoma. Axial CT
image through level of superior mesenteric artery (SMA) shows two discrete
aneurysms of hepatic artery (arrows). These were not described on
axial report.
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Fig. 5B —65-year-old man with clinical suspicion for pancreatic mass.
Patient also had undergone left nephrectomy for renal cell carcinoma. Axial CT
image caudal in relation to A shows dissection of SMA (arrow),
which was not described on axial report.
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Fig. 5C —65-year-old man with clinical suspicion for pancreatic mass.
Patient also had undergone left nephrectomy for renal cell carcinoma. Coronal
volume-rendered 3D CT image shows hepatic artery aneurysms (black
arrows) and SMA dissection (white arrow). These were both
identified with interactive 3D rendering.
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Fig. 6A —83-year-old woman with clinical suspicion for pancreatic
mass. Axial CT image through level of celiac axis shows small focal dissection
(arrow). This finding was not reported on axial dictation.
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Fig. 6B —83-year-old woman with clinical suspicion for pancreatic
mass. Coronal oblique volume-rendered image shows focal dissection flap in
dilated celiac artery. This was described on 3D report. Vascular surgery was
consulted and concluded that this case could be followed and that no immediate
treatment was necessary in this asymptomatic patient.
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Copyright © 2007 by the American Roentgen Ray Society.
