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Diagnostik vaskulärer Erkrankungen als Ursache für das akute Abdomen

Diagnostics of vascular diseases as a cause for acute abdomen

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Zusammenfassung

Vaskuläre Pathologien sind seltene Ursachen für den klinischen Zustand eines akuten Abdomens. Liegt eine vaskuläre Erkrankung vor, ist jedoch aufgrund der hohen Mortalität eine zügige Diagnostik von großer Wichtigkeit. Bei den Erkrankungen der abdominellen Gefäße sind arterielle von venösen Ursachen zu unterscheiden. Ein Verschluss der A. mesenterica superior ist die häufigste Ursache für die akute Mesenterialischämie, daneben sind Blutungen in den abdominellen Gefäßprovinzen des arteriellen Gefäßbaums von Bedeutung. Venöse Pathologien betreffen thrombotische Verschlüsse der Pfortader, der V. mesenterica und der V. cava.

Die Multidetektor-CT (MDCT) ist zur Diagnostik vaskulärer Erkrankungen des Abdominalraums prädestiniert. Mit mehrphasigen Untersuchungsprotokollen gelingt es, den arteriellen und venösen Gefäßbaum zuverlässig darzustellen und Erkrankungen mit hoher Sensitivität und Spezifität zu diagnostizieren. Obwohl die Angiographie bzgl. der Diagnostik weitgehend von der MDCT abgelöst wurde, konnten durch Verbesserungen der Kathetertechnologie neue interventionelle Möglichkeiten geschaffen werden. Hier ist insbesondere an die minimalinvasive Versorgung gastrointestinaler Blutungen zu denken.

Abstract

Vascular pathologies are rare causes of an acute abdomen. If the cause is a vascular disease a rapid diagnosis is desired as vascular pathologies are associated with high mortality. A differentiation must be made between arterial and venous diseases. An occlusion of the superior mesenteric artery is the most common reason for acute mesenteric ischemia but intra-abdominal arterial bleeding is also of great importance. Venous pathologies include thrombotic occlusion of the portal vein, the mesenteric vein and the vena cava.

Multi-detector computed tomography (MDCT) is predestined for the diagnostics of vascular diseases of the abdomen. Using multiphasic contrast protocols enables reliable imaging of the arterial and venous vessel tree and detection of disorders with high sensitivity and specificity. Although conventional angiography has been almost completely replaced by MDCT as a diagnostic tool, it is still of high importance for minimally invasive interventions, for example in the management of gastrointestinal bleeding.

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Literatur

  1. Aschoff AJ, Stuber G, Becker BW et al (2009) Evaluation of acute mesenteric ischemia: accuracy of biphasic mesenteric multi-detector CT angiography. Abdom Imaging 34:345–357

    Article  CAS  PubMed  Google Scholar 

  2. Balthazar EJ, Fisher LA (2001) Hemorrhagic complications of pancreatitis: radiologic evaluation with emphasis on CT imaging. Pancreatology 1:306–313

    Article  CAS  PubMed  Google Scholar 

  3. Biesold M, Ruhlmann C, Kloppel R et al (1996) Acute abdomen in extensive thrombosis in the inferior vena cava collateral circulation. Akt Radiol 6:102–104

    CAS  Google Scholar 

  4. Boley SJ, Kaleya RN, Brandt LJ (1992) Mesenteric venous thrombosis. Surg Clin North Am 72:183–201

    CAS  PubMed  Google Scholar 

  5. Boozari B, Bahr MJ, Kubicka S et al (2008) Ultrasonography in patients with Budd-Chiari syndrome: diagnostic signs and prognostic implications. J Hepatol 49:572–580

    Article  PubMed  Google Scholar 

  6. Bradbury MS, Kavanagh PV, Bechtold RE et al (2002) Mesenteric venous thrombosis: diagnosis and noninvasive imaging. Radiographics 22:527–541

    PubMed  Google Scholar 

  7. Chou CK, Mak CW, Tzeng WS et al (2004) CT of small bowel ischemia. Abdom Imaging 29:18–22

    Article  CAS  PubMed  Google Scholar 

  8. Davidovic L, Dragas M, Bozic V et al (2008) Aneurysm of the inferior vena cava: case report and review of the literature. Phlebology 23:184–188

    Article  CAS  PubMed  Google Scholar 

  9. Erden A, Erden I, Karayalcin S et al (2002) Budd-Chiari syndrome: evaluation with multiphase contrast-enhanced three-dimensional MR angiography. AJR Am J Roentgenol 179:1287–1292

    PubMed  Google Scholar 

  10. Haage P, Gunther RW (2005) Iliofemoral and iliocaval interventions in deep venous thrombosis. Rofo 177:670–680

    CAS  PubMed  Google Scholar 

  11. Horton KM, Fishman EK (2001) Multi-detector row CT of mesenteric ischemia: can it be done? Radiographics 21:1463–1473

    CAS  PubMed  Google Scholar 

  12. Hyare H, Desigan S, Nicholl H et al (2006) Multi-section CT angiography compared with digital subtraction angiography in diagnosing major arterial hemorrhage in inflammatory pancreatic disease. Eur J Radiol 59:295–300

    PubMed  Google Scholar 

  13. Inderbitzi R, Wagner HE, Seiler C et al (1992) Acute mesenteric ischaemia. Eur J Surg 158:123–126

    CAS  PubMed  Google Scholar 

  14. Jaeckle T, Stuber G, Hoffmann MH et al (2008) Detection and localization of acute upper and lower gastrointestinal (GI) bleeding with arterial phase multi-detector row helical CT. Eur Radiol 18:1406–1413

    Article  CAS  PubMed  Google Scholar 

  15. Kirkpatrick ID, 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 

  16. Kuhle WG, Sheiman RG (2003) Detection of active colonic hemorrhage with use of helical CT: findings in a swine model. Radiology 228:743–752

    Article  PubMed  Google Scholar 

  17. Lee SS, Ha HK, Park SH et al (2008) Usefulness of computed tomography in differentiating transmural infarction from nontransmural ischemia of the small intestine in patients with acute mesenteric venous thrombosis. J Comput Assist Tomogr 32:730–737

    Article  PubMed  Google Scholar 

  18. Noone TC, Semelka RC, Siegelman ES et al (2000) Budd-Chiari syndrome: spectrum of appearances of acute, subacute and chronic disease with magnetic resonance imaging. J Magn Reson Imaging 11:44–50

    Article  CAS  PubMed  Google Scholar 

  19. Okuda K, Ohnishi K, Kimura K et al (1985) Incidence of portal vein thrombosis in liver cirrhosis. An angiographic study in 708 patients. Gastroenterology 89:279–286

    CAS  PubMed  Google Scholar 

  20. Pirisi M, Avellini C, Fabris C et al (1998) Portal vein thrombosis in hepatocellular carcinoma: age and sex distribution in an autopsy study. J Cancer Res Clin Oncol 124:397–400

    Article  CAS  PubMed  Google Scholar 

  21. Rhee RY, Gloviczki P (1997) Mesenteric venous thrombosis. Surg Clin North Am 77:327–338

    Article  CAS  PubMed  Google Scholar 

  22. Rosow DE, Sahani D, Strobel O et al (2005) Imaging of acute mesenteric ischemia using multidetector CT and CT angiography in a porcine model. J Gastrointest Surg 9:1262–1274; discussion 1274–1265

    Article  PubMed  Google Scholar 

  23. Tew K, Davies RP, Jadun CK et al (2004) MDCT of acute lower gastrointestinal bleeding. AJR Am J Roentgenol 182:427–430

    PubMed  Google Scholar 

  24. Wiesner W, Khurana B, Ji H et al (2003) CT of acute bowel ischemia. Radiology 226:635–650

    Article  PubMed  Google Scholar 

  25. Wiesner W, Mortele KJ, Glickman JN et al (2001) Pneumatosis intestinalis and portomesenteric venous gas in intestinal ischemia: correlation of CT findings with severity of ischemia and clinical outcome. AJR Am J Roentgenol 177:1319–1323

    CAS  PubMed  Google Scholar 

  26. Wildermuth S, Leschka S, Alkadhi H et al (2005) Multislice CT in the pre- and postinterventional evaluation of mesenteric perfusion. Eur Radiol 15:1203–1210

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Ulm, Deutschland

    M.S. Juchems

  2. Abteilung für Radiologie, Klinikum Kempten-Oberallgäu, Robert-Weixler-Str. 50, 87439, Kempten, Deutschland

    A.J. Aschoff

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  1. M.S. Juchems
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Juchems, M., Aschoff, A. Diagnostik vaskulärer Erkrankungen als Ursache für das akute Abdomen. Radiologe 50, 246–251 (2010). https://doi.org/10.1007/s00117-009-1904-1

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  • DOI: https://doi.org/10.1007/s00117-009-1904-1

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