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2020 Nov 19

Rev Esp Enferm Dig




García Rivera E, Cenizo Revuelta N, Fidalgo Domingos L, Vaquero Puerta C
Rev Esp Enferm Dig. 2020 Nov 19; 113.
PMID: 33207894.


A 50-year-old male patient, without a previous medical history, presented sudden severe abdominal pain with no alterations in the blood analysis. A CT-Angiography (CTA) was performed that showed a wall thickening of the celiac trunk extended to the hepatic artery with a filiform lumen and no involvement of the splenic artery (Figure 1). There were no signs of intestinal or liver ischemia, therefore no further radiological tests were performed. The proteinogram and serology were normal, with no immunological and acute phase reactant markers, excluding vasculitis. It appeared as an isolated lesion with no signs of arterial dissection or pseudoaneurysms of the remaining abdominal vessels or the aorta. Therefore, it was considered as a Segmental Arterial Mediolisis (SAM). A conservative treatment was performed with analgesics, blood pressure control and simple antiplatelet treatment with low-dose aspirin (100mg). The patient presented a complete resolution of the abdominal pain. The follow-up CTA performed showed a significant improvement of the hepatic artery stenosis at 7-days (Figure 2) and complete resolution and minimal wall thickening of the celiac trunk at 30-days (Figure 3). DISCUSSION SAM is a rare, underestimated, non-arteriosclerotic and non-inflammatory disease. The most commonly affected vessels are the visceral trunks1. The differential diagnosis includes systemic inflammatory vasculitis, collagenopathies or fibromuscular dysplasia2. Corticosteroids and immunosuppressive treatments used in other vasculitis do not add any benefits. Conservative treatment with antiplatelet therapy is the first-line option, which lead to a complete remission in some cases. Surgical treatment is reserved for progressive lesions and/or acute complications3.