title: Isolated spontaneous dissection of a visceral artery: a rare cause of epigastric pain.
abstract: BACKGROUND
  Isolated spontaneous dissection of the celiac trunk or superior mesenteric artery is rarely considered in patients with acute abdominal pain. However, with advances in computed tomography (CT) technology, more cases are being detected.
  
  
  OBJECTIVE
  The aim of this study was to describe the clinical manifestation and the classical CT features of isolated spontaneous celiac trunk and superior mesenteric artery (SMA) dissection.
  
  
  METHODS
  The records of seven patients were reviewed to assess demographic data, presenting symptoms, location of dissection, diagnostic modalities, imaging findings, complications, and treatment.
  
  
  RESULTS
  Six patients were men. The average age was 57 years (range, 44-80). Six had epigastric pain and one was asymptomatic. All were diagnosed by CT. The location of dissection was the celiac trunk in three and SMA in four. In all cases, the diagnosis was made by identifying an intimal flap on contrast-enhanced CT images. Extension of dissection to the hepatic artery was found in three patients. A number of associated imaging findings were also present: infiltration of the fat surrounding the vessel (four cases), aneurysmal dilatation (six), thrombosed false lumen (four), significant stenosis (two), and additional aortic or visceral artery aneurysm (four). One patient had renal infarction 2 weeks after initial presentation. Extensive evaluation of all patients revealed no serologic evidence to support the presence of vasculitis or an inflammatory disorder. All were treated conservatively with antihypertensive drugs, anti-inflammatory drugs, steroids, and anticoagulants.
  
  
  CONCLUSIONS
  Isolated spontaneous splanchnic artery dissection should be considered in the differential diagnosis of acute abdominal pain.
authors.affiliation: Department of Radiology, Hillel Yaffe Medical Center, P.O.B. 169, 38100, Hadera, Israel, raufzeina3@hotmail.com.
authors.forename: Abdel-Rauf
authors.initials: AR
authors.lastname: Zeina
authors.forename: Alicia
authors.initials: A
authors.lastname: Nachtigal
authors.forename: Ahmad
authors.initials: A
authors.lastname: Mahamid
authors.forename: Uri
authors.initials: U
authors.lastname: Soimu
authors.forename: Itamar
authors.initials: I
authors.lastname: Ashkenazi
authors.forename: Michael
authors.initials: M
authors.lastname: Oster
mesh_terms: D015746:Abdominal Pain / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000000981:diagnostic imaging* / Q000188:drug therapy; D002445:Celiac Artery / Q000000981:diagnostic imaging*; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007479:Iopamidol / Q000031:analogs & derivatives; D008297:Male; D008638:Mesenteric Arteries / Q000000981:diagnostic imaging*; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol