Imaging

Mesenteric Thrombosis

Preliminary Diagnosis: Mesenteric Thrombosis

I. What imaging technique is first-line for this diagnosis?

  • CT of abdomen and pelvis utilizing CTA protocol

II. Describe the advantages and disadvantages of this technique for diagnosis of mesenteric thrombosis.

Advantages

  • Relatively fast and efficient imaging modality

  • Offers exquisite visualization of the anatomical structures including the vascular, soft tissue, lymphatic, and osseous structures

  • Highly sensitive and specific in diagnosing and detecting the amount and location of stenosis within the mesenteric arteries

  • May help guide treatment

  • Vascular calcifications are well detailed on CT imaging.

Disadvantages

  • Exposes patients to ionizing radiation

III. What are the contraindications for the first-line imaging technique?

  • May be contraindicated in pregnant patients

IV. What alternative imaging techniques are available?

  • MR of the abdomen and pelvis with IV contrast

  • Ultrasound

  • Catheter angiography

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of mesenteric thrombosis.

MR of the abdomen and pelvis MRA protocol

Advantages

  • Does not expose patients to ionizing radiation.

  • Able to well identify and detail the underlying soft tissues

  • Useful for excluding other causes of abdominal pain

  • Offers great visualization and sensitivity in evaluating for abdominal and pelvic collateral arterial circulation

Disadvantages

  • Expensive

  • Time consuming

  • Requires significant patient cooperation to minimize motion artifact

  • Offers less exquisite visualization of the vascular structures and is less adept in detailing location and quantity of vascular occlusion compared with CT imaging

Ultrasound

Advantages

  • Highly portable and relatively inexpensive imaging modality

  • Does not expose patients to ionizing radiation

Disadvantages

  • Highly operator dependent.

  • Less sensitive and specific in detecting and characterizing vascular lesions

  • Less sensitive and specific in identifying vascular calcifications compared with CT imaging

Catheter angiography

Advantages

  • Gold standard for diagnosing and treating mesenteric thrombosis

Disadvantages

  • Exposes patients to large amounts of ionizing radiation

  • Associated with greater morbidity and mortality because of the invasiveness of the procedure

VI. What are the contraindications for the alternative imaging techniques?

MR of the abdomen and pelvis MRA protocol

  • Contraindicated in patients with non–MR-compatible hardware

Ultrasound

  • No specific contraindications exist.

Catheter Angiography

  • Contraindicated in patients in a severe hypocoagulable state

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