Skip to main content

Advertisement

Log in

Errors in MDCT diagnosis of acute mesenteric ischemia

  • Special Section: Intestinal ischemia
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

The causes of diagnostic errors during daily medical practice can be several, mainly attributable to perceptual, interpretive and communication factors. The eventuality of radiological error is much more amplified in the emergency setting where a high number of complex multidetector-row computed tomography (MDCT) images must be evaluated quickly and critical time decisions need to be taken. In particular, in this context, the diagnosis of vascular intestinal diseases represents a crucial and difficult challenge in case of acute abdominal pain given the importance of being able to identify patient with high suspicious for intestinal ischemia and for a specific patient to judge if his ischemia is reversible or irreversible. Awareness of potential biases which can lead to diagnostic errors together with an extensive knowledge of the imaging features of these pathologies can lead to promptly recognize them with fewer mistakes, improving patients’ outcome. This article reviews the MDCT findings of acute intestinal ischemia and acute colonic ischemia and analyzes the main types of diagnostic errors, underlining the importance of being familiarized with them to avoid misdiagnosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11

Similar content being viewed by others

References

  1. Brook OR, O’Connell AM, Thornton E, Eisenberg RL, Mendiratta-Lala M, Kruskal JB (2010) Quality initiatives: anatomy and pathophysiology of errors occurring in clinical radiology practice. Radiographics 30:1401-1410.

    Article  PubMed  Google Scholar 

  2. Pinto A, Caranci F, Romano L, Carrafiello G, Fonio P, Brunese L (2012) Learning from errors in radiology: a comprehensive review. Semin Ultrasound CT MR 33:379-382.

    Article  PubMed  Google Scholar 

  3. Pinto A, Brunese L (2010) Spectrum of diagnostic errors in radiology. World J Radiol 2:377-383.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Mandato Y, Reginelli A, Galasso R, Iacobellis F, Berritto D, Cappabianca S. (2012) Errors in the radiological evaluation of the alimentary tract: part I. Semin Ultrasound CT MR. 33:300-307.

    Article  PubMed  Google Scholar 

  5. Reginelli A, Mandato Y, Solazzo A, Berritto D, Iacobellis F, Grassi R. (2012) Errors in the radiological evaluation of the alimentary tract: part II. Semin Ultrasound CT MR.33:308-317.

    Article  PubMed  Google Scholar 

  6. Egri C, Darras KE, Scali EP, Harris AC (2018) Classification of error in abdominal imaging: pearls and pitfalls for radiologists. Can Assoc Radiol J. 69:409-416.

    Article  PubMed  Google Scholar 

  7. McCreadie G, Oliver TB (2009) Eight CT lessons that we learned the hard way: an analysis of current patterns of radiological error and discrepancy with particular emphasis on CT. Clin Radiol 64:491-499.

    Article  CAS  PubMed  Google Scholar 

  8. Mazzei MA, Volterrani L (2015) Errors in multidetector row computed tomography. Radiol Med.120:785-794.

    Article  CAS  PubMed  Google Scholar 

  9. Berlin L (2000) Malpractice issues in radiology: alliterative errors. AJR Am J Roentgenol 174:925-931.

    Article  CAS  PubMed  Google Scholar 

  10. Pinto A, Pinto F, Faggian A, Rubini G, Caranci F, Macarini L, Genovese EA, Brunese L (2013) Sources of error in emergency ultrasonography. Crit Ultrasound J 5(Suppl 1):S1.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Pinto A, Brunese L, Pinto F, Reali R, Daniele S, Romano L (2012) The concept of error and malpractice in radiology. Semin Ultrasound CT MRI 33:275-279.

    Article  Google Scholar 

  12. Ullery BS, Boyko AT, Banet GA, Lawrence ML (2004) Colonic ischemia: an under recognized cause of lower gastrointestinal bleeding. J Emerg Med 2004;27:1-5.

    Article  PubMed  Google Scholar 

  13. Kärkkäinen JM, Saari P, Kettunen HP, Lehtimäki TT, Vanninen R, Paajanen H, Manninen H (2016) Interpretation of abdominal CT findings in patients who develop acute on chronic mesenteric ischemia. J Gastrointest Surg. 20:791-802.

    Article  PubMed  Google Scholar 

  14. Mazzei MA, Guerrini S, Cioffi Squitieri N, Genovese EA, Mazzei FG, Volterrani L (2012) [Diagnosis of acute mesenteric ischemia/infarction in the era of multislice CT]. Recenti Prog Med 103:435-437. Italian.

  15. Terlouw LG, Moelker A, Abrahamsen J, Acosta S, Bakker OJ, Baumgartner I, Boyer L, Corcos O, van Dijk LJ, Duran M, Geelkerken RH, Illuminati G, Jackson RW, Kärkkäinen JM, Kolkman JJ, Lönn L, Mazzei MA, Nuzzo A, Pecoraro F, Raupach J,Verhagen HJ, Zech CJ, van Noord D, Bruno MJ (2020) European guidelines on chronic mesenteric ischaemia - joint United European Gastroenterology, European Association for Gastroenterology, Endoscopy and Nutrition, European Society of Gastrointestinal and Abdominal Radiology, Netherlands Association of Hepatogastroenterologists, Hellenic Society of Gastroenterology, Cardiovascular and Interventional Radiological Society of Europe, and Dutch Mesenteric Ischemia Study group clinical guidelines on the diagnosis and treatment of patients with chronic mesenteric ischaemia. United European Gastroenterol J. 16:2050640620916681 [Epub ahead of print]

  16. Romano L, Scuderi MG, Daniele S (2012) Crohn’s disease: errors of interpretation in emergency MDCT evaluation. In: Romano L, Pinto A (Editors) Errors in Radiology. Chapter 16, pag.177-194. Springer-Verlag Italia.

  17. T.T. Lehtimäki, JM Kärkkäinen, P Saari et al (2015) Detecting acute mesenteric ischemia in CT of the acute abdomen is dependent on clinical suspicion: Review of 95 consecutive patients, Eur J Radiol 84:2444-53.

    Article  PubMed  Google Scholar 

  18. Stoney RJ, Cunningham CG (1993) Acute mesenteric ischemia. Surgery.114:489-90.

    CAS  PubMed  Google Scholar 

  19. Kärkkäinen JM, Lehtimäki TT, Manninen H, Paajanen H (2015) Acute mesenteric ischemia is a more common cause than expected of acute abdomen in the elderly. J Gastrointest Surg 19:1407-1414.

    Article  PubMed  Google Scholar 

  20. Tilsed JV, Casamassima A, Kurihara H, Mariani D, Martinez I, Pereira J, Ponchietti L, Shamiyeh A, Al-Ayoubi F, Barco LA, Ceolin M, D’Almeida AJ, Hilario S, Olavarria AL, Ozmen MM, Pinheiro LF, Poeze M, Triantos G, Fuentes FT, Sierra SU, Soreide K, Yanar H (2016) ESTES guidelines: acute mesenteric ischaemia. Eur J Trauma Emerg Surg 42:253-270

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Oliva IB, Davarpanah AH, Rybicki FJ, Desjardins B, Flamm SD, Francois CJ, Gerhard-Herman MD, Kalva SP, Ashraf Mansour M, Mohler ER 3rd, Schenker MP, Weiss C, Dill KE (2013) ACR appropriateness criteria imaging of imaging mesenteric ischemia. Abdom Imaging 38: 714-719

    Article  PubMed  Google Scholar 

  22. Cudnik MT, Darbha S, Jones J, Macedo J, Stockton SW, Hiestand BC (2013) The diagnosis of acute mesenteric ischemia: a systematic review and meta-analysis. Acad Emerg Med 20:1087-1100.

    Article  PubMed  Google Scholar 

  23. Furukawa A, Kanasaki S, Kono N, Wakamiya M, Tanaka T, Takahashi M, Murata K (2009) CT diagnosis of acute mesenteric ischemia from various causes. Am J Roentgenol. 192:408-416.

    Article  Google Scholar 

  24. McLeod R, Lindsay T, O’Malley M (2005) Evidence based reviews in surgery group. Canadian Association of General Surgeons and American College of Surgeons evidence based reviews in surgery.15. Biphasic CT with mesenteric CT angiography in the evaluation of acute mesenteric ischemia: initial experience. Can J Surg. 48:491-493.

    PubMed  PubMed Central  Google Scholar 

  25. Barmase M, Kang M, Wig J, Kochhar R, Gupta R, Khandelwal N (2011) Role of multidetector CT angiography in the evaluation of suspected mesenteric ischemia. Eur J Radiol. 80:e582–7

    Article  PubMed  Google Scholar 

  26. Murphy KP, Twomey M, McLaughlin PD, O’Connor OJ, Maher MM (2015) Imaging of ischemia, obstruction and infection in the abdomen. Radiol Clin North Am 53:847-869.

    Article  PubMed  Google Scholar 

  27. Copin P, Ronot M, Nuzzo A, Maggiori L, Bouhnik Y, Corcos O, Vilgrain V; SURVI team (2018) Inter-reader agreement of CT features of acute mesenteric ischemia. Eur J Radiol. 105:87-95.

    Article  PubMed  Google Scholar 

  28. Pinto A, Miele V, Schillirò ML, Nasuto M, Chiaese V, Romano L, Guglielmi G (2016) Spectrum of Signs of Pneumoperitoneum. Semin Ultrasound CT MR. 37:3-9.

    Article  PubMed  Google Scholar 

  29. Kirkpatrick IDC, Kroeker MA, Greenberg HM (2003) Biphasic CT with mesenteric CT angiography in the evaluation of acute mesenteric ischemia: initial experience. Radiology. 229:91-98.

    Article  PubMed  Google Scholar 

  30. Romano S, Niola R, Maglione F, Romano L (2008) Small bowel vascular disorders from arterial etiology and impaired venous drainage. Radiol Clin North Am 46: 891-908.

    Article  PubMed  Google Scholar 

  31. Mazzei MA, Volterrani L. (2015) Nonocclusive mesenteric ischaemia: think about it.Radiol Med. 120:85-95.

  32. Firetto MC, Lemos AA, Marini A, Avesani EC, Biondetti PR (2013) Acute bowel ischemia: analysis of diagnostic error by overlooked findings at MDCT angiography. Emerg Radiol. 139-147.

  33. Mazzei MA, Gentili F, Mazzei FG, Grassi R, Volterrani L (2018) Non-occlusive mesenteric ischaemia: CT findings, clinical outcomes and assessment of the diameter of the superior mesenteric artery: Don’t forget the reperfusion process! Br J Radiol. 92(1093):20180736.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Mazzei MA, Guerrini S, Cioffi Squitieri N, Vindigni C, Imbriaco G, Gentili F, Berritto D, Mazzei FG, Grassi R, Volterrani L (2016) Reperfusion in non-occlusive mesenteric ischaemia (NOMI): effectiveness of CT in an emergency setting. Br J Radiol 89:20150956.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Nakashima K, Ishimaru H, Fujimoto T, Mizowaki T, Mitarai K, Nakashima K, Matsuoka Y, Uetani M (2015) Diagnostic performance of CT findings for bowel ischemia and necrosis in closed-loop small-bowel obstruction. Abdom Imaging. 40:1097-1103.

    Article  PubMed  Google Scholar 

  36. Mazzei MA, Gentili F, Volterrani L (2019) Dual-Energy CT Iodine mapping and 40-keV monoenergetic applications in the diagnosis of acute bowel ischemia: a necessary clarification. AJR Am J Roentgenol. 212:W93-W94.

    Article  PubMed  Google Scholar 

  37. Mazzei MA, Guerrini S, Lucii G, Mazzei FG, Volterrani L (2020) Bowel obstruction and intestinal ischemia: warnings for radiologists. Abdom Radiol (NY) 45:887–888

    Article  CAS  Google Scholar 

  38. Cotter TG, Bledsoe AC, Sweetser S (2016) Colon ischemia: an update for clinicians. Mayo Clin Proc. 91:671-677.

    Article  PubMed  Google Scholar 

  39. Feuerstadt P, Brandt LJ (2015) Update on colon ischemia: recent insights and advances. Curr Gastroenterol Rep.17:45.

    Article  PubMed  Google Scholar 

  40. Flynn AD, Valentine JF (2016) Update on the diagnosis and management of colon ischemia. Curr Treat Options Gastroenterol 14:128-139.

    Article  PubMed  Google Scholar 

  41. Cole JA, Cook SF, Sands BE, Ajene AN, Miller DP, Walker AM (2004) Occurrence of colon ischemia in relation to irritable bowel syndrome. Am J Gastroenterol. 99:486-491.

    Article  PubMed  Google Scholar 

  42. Longstreth GF, Yao JF (2009) Epidemiology, clinical features, high-risk factors, and outcome of acute large bowel ischemia. Clin Gastroenterol Hepatol. 7:1075-1080.

    Article  PubMed  Google Scholar 

  43. Brandt LJ, Feuerstadt P, Longstreth GF, Boley SJ, American College of G (2015) ACG clinical guideline: epidemiology, risk factors, patterns of presentation, diagnosis, and management of colon ischemia (CI). Am J Gastroenterol. 110:18-44.

    Article  PubMed  Google Scholar 

  44. Jessurun J (2017) The differential diagnosis of acute colitis: clues to a specific diagnosis. Surg Pathol Clin.10:863-885.

    Article  PubMed  Google Scholar 

  45. Valentini V, Buquicchio GL, Galluzzo M, Ianniello S, Di Grezia G, Ambrosio R, Trinci M, Miele V (2016) Intussusception in adults: the role of MDCT in the identification of the site and the cause of the obstruction. Gastroenterol Res Pract 2016:5623718.

    Article  PubMed  Google Scholar 

  46. Sessa B, Galluzzo M, Ianniello S, Pinto A, Trinci M, Miele V (2016) Acute perforated diverticulitis: assessment with multidetector Computed Tomography. Seminars Ultrasound CT MRI 37:37-48.

    Article  Google Scholar 

  47. Kimura J, Lefor AK, Kubota T (2018) Colonic ischemia mimicking obstruction due to sigmoid colon cancer: A case report. Int J Surg Case Rep. 46:38-40.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Abreu MT, Harpaz N (2007) Diagnosis of colitis: making the initial diagnosis. Clin Gastroenterol Hepatol 5:295-301.

    Article  PubMed  Google Scholar 

  49. Farooq PD, Urrunaga NH, Tang DM, von Rosenvinge EC (2015) Pseudomembranous colitis. Dis Mon 61:181-206

    Article  PubMed  PubMed Central  Google Scholar 

  50. Guerri S, Danti G, Frezzetti G, Lucarelli E, Pradella S, Miele V (2019) Clostridium difficile colitis: CT findings and differential diagnosis. Radiol Med. 124:1185-1198

    Article  PubMed  Google Scholar 

  51. Berritto D, Iacobellis F, Mazzei MA, Volterrani L, Guglielmi G, Brunese L, Grassi R (2016) MDCT in ischaemic colitis: how to define the aetiology and acute, subacute and chronic phase of damage in the emergency settings. Br J Radiol 89(1061):20158021

    Article  Google Scholar 

  52. Di Grezia G, Gatat G, Rella R, Iacobellis F, Berritto D, Musto LA, Grassi R (2016) MDCT in acute ischaemic left colitis: a pictorial essay. Radiol Med 124: 103-108

    Article  Google Scholar 

  53. Mazzei MA, Guerrini S, Cioffi Squitieri N, Imbriaco G, Chieca R, Civitelli S, Savelli V, Mazzei FG, Volterrani L (2013). Magnetic resonance imaging: is there a role in clinical management for acute ischemic colitis? World J Gastroenterol 19:1256-1263.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Saba L, Berritto D, Iacobellis F, Scaglione M, Castaldo S, Cozzolino S, Mazzei MA, Di Mizio V, Grassi R (2013) Acute arterial mesenteric ischemia and reperfusion: macroscopic and MRI findings, preliminary report. World J Gastroenterol. 19:6825-6833.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

The authors declare that they do not receive any funding for the publication of this article.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Gloria Addeo.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest related to the publication of this article.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Research involved in human and animal rights

This article does not contain any studies with animals performed by any of the authors.

Informed consent

For this type of study formal consent is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pinto, A., Lanzetta, M.M., Addeo, G. et al. Errors in MDCT diagnosis of acute mesenteric ischemia. Abdom Radiol 47, 1699–1713 (2022). https://doi.org/10.1007/s00261-020-02732-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-020-02732-y

Keywords

Navigation