ARRS 2022 Abstracts

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E2000. Overlooked Chronic Mesenteric Ischemia as a Mimicker
Authors
  1. Mohammad-Mehdi Mehrabinejad; Tehran University of Medical Sciences
  2. Faeze Salahshour; Tehran University of Medical Sciences
Background
Chronic mesenteric venous thrombosis (MVT), comprises 20–40% of all MVT cases. Abdominal CT scan with contrast medium is the modality of choice, with about 90% accuracy. This relatively uncommon condition might be an incidental finding or diagnosed by evidence of portal hypertension. Timely diagnosis and treatment of MVT is the main factor affecting the patients’ outcome. Given its nonspecific clinical and laboratory findings, radiologic modalities are highly suggested to minimize the diagnosis delay. Missed mesenteric venous thrombosis may be lethal, but some cases recovered with residual stenosis of the SMV or its branches, leading to chronic abdominal pain evaluated by CT scan.

Educational Goals / Teaching Points
In this presentation, we review the most common types of chronic MVT CT findings that imitate other differential diagnoses with the relatively same presentations and consequently interrupt the timely diagnosis and treatment.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Several secondary findings could mimic other disease processes and mask underlying remote thrombosis, causing misdiagnosis and mismanagement. Crohn’s disease, bowel and mesenteric tumors, lymphoma, and mesenteric panniculitis may simulate by remote venous thrombosis on the CT scan. Obstruction and GI bleeding with unknown origin are other clinical presentations besides chronic abdominal pain. To avoid misdiagnoses, we recommend radiologists carefully follow all vessels’ entire course to detect the focal narrowing as far as the distal branches.Collateral vessels in chronic MVT originate from the venous system; however, comb signs in Crohn’s disease are prominent arteries. Although rare, we reviewed almost all deceptive radiologic manifestations of chronic MVT, all of which could be ruled out by following the collaterals and mesenteric vasculature. This point could minimize further invasive and costly investigations as well as presentation-to-treatment time, providing a more favorable outcome. Our findings should be confirmed through further investigations on a larger sample size.

Conclusion
Radiologists should be aware of similar conditions that could mimic CT features of chronic MVT . Greater attention to mesenteric vasculature and collaterals in abdominal CT scans of patients with clinical suspicion for chronic MVT could minimize the misdiagnosis.