MESENTERIC ISCHAEMIA ULTRASOUND SIGNS
Category: Diagnostic Radiology
Abstract : Mesenteric ischaemia is a potentially lethal condition, associated with atherosclerosis of the mesenteric vessels, which can cause bowel necrosis and death if left untreated. It is a difficult diagnosis to make on clinical grounds because the symptoms are varied and non-specific, including acute abdominal pain following meals, diarrhoea and subsequent weight loss. Patients frequently underg
Mesenteric ischaemia is a potentially lethal condition, associated with atherosclerosis of the mesenteric vessels, which can cause bowel necrosis and death if left untreated. It is a difficult diagnosis to make on clinical grounds because the symptoms are varied and non-specific, including acute abdominal pain following meals, diarrhoea and subsequent weight loss.
Patients frequently undergo a number of comparatively invasive investigations before a diagnosis is reached, and this delay increases the mortality and morbidity of the condition. Treatment involves restoring the blood flow via angioplasty or surgery and, if necessary, resecting segments of necrosed bowel.
Atherosclerosis may be demonstrated in the SMA in a number of cases. Signs of occlusion or stenosis of the SMA may be identified with colour or power Doppler as a filling defect within the lumen of the vessel. However, significant stenoses have been diagnosed with Doppler in a relatively high percentage (18%) of the asymptomatic, elderly population. The finding of a stenosis on ultrasound, therefore, is an indication for further imaging in symptomatic patients, rather than an absolute indicator of mesenteric ischaemia.
In a normal patient, the response of the SMA to food can be demonstrated as an increase in end diastolic flow velocities. Mesenteric compromise has also been associated with an abnormal postprandial response; Doppler waveforms of the SMA have decreased peak systolic and end diastolic velocities after food.
None of these ultrasound signs and appearances are specific for mesenteric ischaemia; the mesentery is supplied by three arteries which cannot all be evaluated with ultrasound and, in addition, numerous other conditions are associated with altered SMA Doppler resistance, including inflammatory bowel conditions, haemorrhage, elevation of venous pressure and cirrhosis.
Hit: 211 times
Related Articles in Diagnostic Radiology :
|
Advertise with Health Information Encyclopedia