Transient, marked flattening of the abdominal aorta, iliac arteries, and venous structures during active vomiting: report of a case demonstrated by MDCT

Abstract

In recent years, intra-abdominal hypertension has gained greater recognition both clinically and radiologically. Its most clinically significant form occurs when intra-abdominal pressure (IAP) is sustained at high pressures for long periods of time. This is known as abdominal compartment syndrome (ACS), which is a surgical emergency with high morbidity and mortality rates even when treated appropriately and its imaging characteristics are well described in the literature. However, it is known that IAP reaches far higher pressures transiently during certain maneuvers, such as Valsalva maneuvers like coughing and vomiting. The effect of the severely, markedly increased IAP on imaging findings during Valsalva maneuvers has rarely been visually depicted since cross-sectional imaging is typically not performed during these episodes and older CT scanners acquired images too slowly to capture these brief moments. We report a case with unique arterial findings related to the massively increased IAP generated by vomiting during MDCT acquisition that differentiates intense Valsalva maneuvers, such as vomiting, from ACS radiologically.