title: Isolated celiac and superior mesenteric artery dissection identified with MDCT: imaging findings and clinical course.
abstract: OBJECTIVE
  Isolated celiac or superior mesenteric artery (SMA) dissection is a rare entity in the absence of aortic dissection. Our objective was to detail imaging and clinical course of celiac and or SMA dissections.
  
  
  METHODS
  We conducted a retrospective search from 2004 to 2010 using "celiac and/or SMA dissection" keywords. Analysis of medical record and imaging at diagnosis and follow-up was performed. Dissections for any reason without aortic dissection were included.
  
  
  RESULTS
  Twenty-four celiac and 18 SMA dissections were detected in 38 patients. One third of the dissections diagnosed with interactive multiplanar reconstruction/maximum intensity projection (MIP)/3-dimensional (3D) rendering were missed on standard imaging planes. No patients had bowel ischemia or died. Eighty-four percent of the patients were observed, 2 patients received anticoagulation, 2 patients received surgical repair, and 3 patients received stenting. Twenty-three of 25 cases treated with observation exhibited no change or improvement/resolution (2/25) with 20.9-month mean follow-up.
  
  
  CONCLUSIONS
  Most isolated celiac and SMA dissections were asymptomatic/incidental, supporting observation and surveillance with intervention reserved for vascular compromise. Interactive multiplanar reconstruction/maximum intensity projection/3D rendering can increase diagnostic sensitivity.
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD 21287, USA. FV fverde1@jhmi.edu
authors.forename: Franco
authors.initials: F
authors.lastname: Verde
authors.forename: Karen B
authors.initials: KB
authors.lastname: Bleich
authors.forename: Alexander
authors.initials: A
authors.lastname: Oshmyansky
authors.forename: James H
authors.initials: JH
authors.lastname: Black
authors.forename: Elliot K
authors.initials: EK
authors.lastname: Fishman
authors.forename: Pamela T
authors.initials: PT
authors.lastname: Johnson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000000981:diagnostic imaging* / Q000628:therapy; D002445:Celiac Artery / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging*; D008875:Middle Aged; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*