Ultrasound diagnosis of superior mesenteric artery aneurysm: two case reports

Color Doppler sonography for preoperative diagnosis of an aneurysm of the ileal branch of the superior mesenteric artery

Aneurysms of the superior mesenteric artery are uncommon, and aneurysms of its branches occur even less frequently. We report the case of a 60-year-old man with an aneurysm of the ileal branch of the superior mesenteric artery whose initial symptom was abdominal pain. Gray-scale and color Doppler sonography provided noninvasive, accurate preoperative identification of the aneurysm despite its uncommon location, a small branch of the superior mesenteric artery. CT and conventional and magnetic resonance angiography confirmed the sonographic diagnosis. The aneurysm was resected successfully, and the patient's postoperative course was uneventful. Although angiography is required for a definitive diagnosis and for surgical planning, sonography is a useful tool for preoperative evaluation and diagnosis of such aneurysms.

Lupus abdominal crisis owing to rupture of an ileocolic aneurysm with successful angiographic treatment

There are many causes of acute abdominal pain, or abdominal "crises," in patients with systemic lupus erythematosus (SLE), most frequently the causes are serositis or vasculitis. Vasculitis generally causes small vessel abnormalities and may present with symptoms owing to mucosal damage, such as pain, diarrhea, or bleeding. We present a patient with SLE who had the acute onset of severe abdominal pain while hospitalized for a lupus flare and who was found to have a ruptured ileocolic aneurysm with intraperitoneal bleeding. She was successfully managed with angiographic embolization, without further complications. Although angiography is well established as a therapeutic intervention for mesenteric aneurysms of various etiologies, this is the first case of an SLE-related ileocolic aneurysm so managed. This entity should be considered in the differential diagnosis of abdominal pain in patients with lupus, and angiographic embolization should be considered in its management.

Superior mesenteric artery aneurysm in systemic lupus erythematosus

We present a case of giant superior mesenteric artery (SMA) aneurysm in a patient with systemic lupus erythematosus (SLE). The ultrasound, computed tomography, magnetic resonance, and angiographic findings are discussed. To our knowledge, SLE associated with a giant SMA aneurysm as a late complication of previous lupus mesenteric arteritis has not been reported previously.

Pseudoaneurysms complicating organ transplantation: roles of CT, duplex sonography, and angiography

In a retrospective study of proved pseudoaneurysms (PAs) in 15 patients with transplanted organs (11 liver, three kidney, one pancreas), the results of computed tomography (CT), duplex sonography, and angiography were reviewed. Of the 15 cases of PA, eight occurred at the arterial anastomosis and seven were nonanastomotic. Three of the eight anastomotic PAs were caused by infection. Of the seven nonanastomotic PAs, four were caused by percutaneous biopsy, two were caused by infection, and one was of undetermined cause. In nine (60%) of the 15 patients the PAs were incidentally detected at imaging studies performed for other reasons. Diagnosis requires a high degree of suspicion. CT was performed in nine cases and duplex sonography in ten. The diagnosis of PA was made with CT in six (67%) patients and with duplex sonography in five (50%). CT and duplex sonography could not enable diagnosis when the PA was small, when the arterial anastomosis was not included in the field of study, or when enhancement with intravenously administered contract material was suboptimal. Angiography depicted the PAs in all 15 patients. In three liver transplant recipients with gastrointestinal tract bleeding, the causative PAs were detected only with angiography.

Pseudoaneurysm of anomalous right hepatic artery as a cause for hemosuccus pancreatitis

A pseudoaneurysm from the right hepatic artery was associated with chronic pancreatitis in an elderly patient with recurrent episodes of bleeding into the pancreas. Preoperative ultrasonography and enhanced computed tomographic scan revealed the nature of lesion but angiography was required to demonstrate the causative right hepatic artery, which was anomalous.