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A 23-year-old woman with a medical history of a tooth abscess leading to subacute bacterial endocarditis, left cerebral ischemia, and hemorrhagic stroke and a history of the lupus anticoagulant presented with symptoms of acute upper abdominal pain to the Westchester Medical Center University Hospital. The pain was steady, moderately severe, and located in the epigastric region with no radiation or shifting. The patient was afebrile and was hemodynamically stable. Physical examination revealed a thin young woman with a large pulsatile mass that was tender to palpation in her midabdomen to the right of the midline. Laboratory values were within a normal range. A contrast-enhanced computed tomographic scan of the abdomen and pelvis was performed (Figure 1). Three-dimensional reconstructions of the computed tomographic scan were also obtained (Figure 2).
Computed tomographic scan of the abdomen with intravenous contrast showing displacement of superior mesenteric artery branches, secondary to mass effect.
Three-dimensional image showing the superior mesenteric artery, its branches, and an aneurysm arising from 1 of its branches.
A. Abdominal aortic aneurysm
B. Superior mesenteric artery aneurysm
C. Superior mesenteric artery syndrome
D. Celiac artery aneurysm
Aziz F, Babu S, Sullivan T, Laskowski I. Image of the Month—Quiz Case. Arch Surg. 2009;144(5):483-484. doi:10.1001/archsurg.2009.50-a