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Special Feature
August 01, 2007

Image of the Month—Quiz Case

Author Affiliations

Author Affiliation:Department of Surgery, Johns Hopkins University, Baltimore, Maryland.


Grace S.RozyckiMD


Copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2007

Arch Surg. 2007;142(8):797. doi:10.1001/archsurg.142.8.797

A 68-year-old man with a history of dyslipidemia and an elevated Lp(a) lipoprotein level developed acute abdominal pain and had tenderness to deep palpation on the right side of his abdomen. A computed tomographic scan demonstrated thickening of the ascending colon consistent with ischemic colitis. Hydration and antibiotic administration rapidly relieved his pain. Subsequent duplex imaging of the superior mesenteric artery revealed poststenotic turbulence and elevated peak velocities were noted. He was referred for angiography (Figure).

Image not available

Diagnostic aortography in a lateral projection revealed 90% to 95% stenosis appreciated at the origin of the celiac axis and the superior mesenteric artery (SMA). The inferior mesenteric artery was occluded. Balloon-expandable 8 × 18-mm stents were deployed in both vessels. The celiac axis stent was dilated to 10 mm to improve a residual stenosis. The patient recovered well and was discharged the next day, tolerating a regular diet and pain free. A, Before stents. B, After stents.

What Is the Diagnosis?

A. Takayasu arteritis

B. Median arcuate ligament syndrome

C. Visceral aortic atherosclerosis

D. Fibromuscular dysplasia