Isolated Spontaneous Dissection of Celiac Artery with Splenic Infarction: Report of a Case
Article Outline
Isolated arterial dissection, which occurs with the absence of aortic dissection, has been reported in carotid and renal arteries but rarely in visceral arteries. We report a case of isolated celiac artery dissection with splenic infarction. The aetiology, clinical features, diagnostic modalities and treatment options are briefly described.
Keywords: Visceral artery dissection, Isolated celiac artery dissection, Splenic infarction
Introduction
Isolated arterial dissection, which occurs with the absence of aortic dissection, has been reported in carotid and renal arteries but rarely in visceral arteries.1, 2 We report a case of isolated celiac artery dissection with splenic infarction.
Case Report
A 52 year-old male presented to the emergency room with abdominal pain and vomiting for 5 days and fever for 2 days. Abdominal pain was in left upper quadrant and radiating to left side of chest. He was not diabetic nor hypertensive. He had no history of trauma.
On examination, his pulse rate was 120/min and blood pressure was 170/100
mmHg. His abdomen was distended with mild tenderness and guarding in epigastrium and left hypochondrium. Active bowel sounds were heard on auscultation. All routine blood investigations including ESR were normal. Contrast enhanced CT, arterial & portal venous phases showed linear luminal narrowing and a thrombosed false lumen extending from the coeliac artery origin to the splenic artery up to the splenic hilum, suggestive of a celiac artery dissection (Fig. 1, Fig. 2). Multiple splenic infarcts were seen. His echocardiogram was normal.
Fig. 1
Contrast enhanced CT scan of the abdomen (arterial phase) showing dissection of celiac artery. Multiple splenic infarcts are seen.
Fig. 2
Contrast enhanced CT scan of the abdomen (arterial phase) showing dissection extending from the celiac artery origin to the splenic artery. Multiple splenic infarcts are seen.
Patient's blood pressure was normalized urgently and he was anticoagulated with heparin. His condition improved and was discharged on antihypertensives and oral anticoagulants. At 3 months follow up he was asymtomatic.
Discussion
Spontaneous dissections of visceral arteries are rare, but when they do occur, they most commonly involve the superior mesenteric artery.3 Isolated spontaneous dissection of celiac artery is extremely rare. Iatrogenic dissection of the celiac artery is a known complication of transcatheter arterial embolization (TAE) for hepatocellular carcinoma. Majority of them heal spontaneously and in most instances allows subsequent TAE.4
Most of the patients present with abdominal pain. There is usually a discrepancy between symptoms and physical signs, with symptoms being more severe than the clinical signs. Depending on the extent of involvement the clinical picture varies from just abdominal pain to severe shock and death.
Arteriography, CT angiography and magnetic resonance (MR) angiography can be used to diagnose this condition.
Because of the risk of ischemic and hemorrhagic complications, surgery should be considered for any patient with celiac artery dissection. The repair procedures that have been described are resection-anastomosis and prosthetic bypass to the hepatic artery.5 With the recent developments in endovascular procedures, stenting might be an option. However, some patients with uncomplicated asymptomatic lesions may be eligible for medical treatment with regular surveillance.5 Our patient had a true lumen which was patent and still partially perfused the spleen. The false lumen was already thrombosed. Hence a conservative approach was chosen.
In patients presenting with persistent abdominal pain and non-specific clinical signs and normal laboratory findings rare causes of abdominal pain should be considered. Visceral ischemia should be considered when the abdominal symptoms are disproportionate compared to the clinical signs. Celiac artery dissection should be considered in the differential diagnosis of acute visceral ischemia. Despite the rarity of visceral artery dissection, awareness of this pathology is crucial, because of its possible life threatening complications. Proper usage of appropriate diagnostic imaging tests early in the course of management will reduce morbidity and mortality.
References
- Isolated dissection of the celiac artery–a case report. Angiology. 2000 Jul;51(7):603–607
- . Spontaneous dissection of visceral blood vesssels–a rare cause of epigastric pain. Schweiz Rundsch Med Prax. 2004 Feb 18;93(8):285–289
- . Surgical treatment of superior mesenteric artery dissecting aneurysm and simultaneous celiac artery compression. Ann Vasc Surg. 1993 Sep;7(5):457–462
- . Iatrogenic dissection of the celiac artery and its branches during transcatheter arterial embolization for hepatocellular carcinoma: outcome in 40 patients. Cardiovasc Intervent Radiol. 1995 Jan–Feb;18(1):16–19
- . Spontaneous dissection of the celiac artery. Ann Vasc Surg. 2001 Nov;15(6):687–692
PII: S1533-3167(06)00093-8
doi:10.1016/j.ejvsextra.2006.11.004
© 2006 Elsevier Ltd. All rights reserved.
Refers to article:
- Isolated Celiac Artery Dissection with Splenic Infarction: Report of a Case , 15 March 2007
