Introduction.- Duplex interrogation of the mesenteric arteries is a frequent practice during the workup of chronic mesenteric ischemia (CMI). We report a case in which duplex ultrasound identified a stenosis of the inferior mesenteric artery (IMA) that was not initially detected on either angiogram or computed tomography angiography (CTA). Case Report.- A 72-year-old Hispanic man with a history of CMI presented with a 1-week history of vague postprandial abdominal pain that became severe and constant during the last 3 days. The patient was admitted and an aortic angiogram was performed, demonstrating a normal celiac axis and IMA, and short segment superior mesenteric artery (SMA) occlusion with reconstitution via a large meandering branch of the IMA. Aortic duplex was also performed that confirmed the occlusion of the SMA and demonstrated significant velocity elevation (>450 mm/sec) with color flow disturbances suggestive of high-grade stenosis at the origin of the IMA. This duplex ultrasound finding prompted further investigation with CTA of the abdomen and pelvis, which demonstrated a high-grade stenosis of the celiac axis, occlusion of the SMA, and an atherosclerotic plaque in the infrarenal aorta near the origin of the IMA without evidence of stenosis. Because of the patient's persistent abdominal symptoms and disparate imaging results, a repeat angiogram with multiple views was able to identify both the celiac and IMA stenoses, each of which was successfully treated with stents. The patient's abdominal symptoms resolved within 4 days. Three months after stenting, the patient remains symptom free, and a follow-up duplex examination showed patency of both the celiac artery and IMA stents. Conclusion.- Multiple imaging modalities are often essential in the work up for patients with CMI. This case demonstrates the sensitivity of duplex ultrasound in the identification of an IMA stenosis in a patient with a known occlusion of the SMA, and not initially identified on the angiogram or CTA.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging
- Cardiology and Cardiovascular Medicine