PMC3919902_01
(A) Abdominal radiograph revealed fecal material in the right colon (arrowhead) with thread-like radiopaque densities representing vascular calcifications over the ascending and transverse colon (arrows). (B) CT revealed numerous serpentine calcifications (arrow) and stenosis (arrowhead) of the hepatic flexure of the colon with wall thickening (arrow tail). (C) CT also showed serpentine calcifications of the superior mesenteric vein and its tributaries of the ascending and transverse colon (arrowhead and arrow). Marked calcification of the inferior mesenteric vein and its tributaries of the descending colon was noted (arrow tail). In addition, wall thickening of the ascending, transverse and proximal descending colon, associated with poor contrast enhancement, was observed (arrow with oblique lines). CT, computed tomography.
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An abdominal radiograph revealed thread-like radiopaque densities in the right upper quadrant (Fig. 1A).
SMA angiography. (A) Arterial phase showed a patent SMA with smooth contour and normal flow; however, there was torturous narrowing and a decreased number of tributaries over the ascending and transverse colon (dashed circle). (B) Venous phase revealed markedly decreased flow in the mesenteric vein and its tributaries over the ascending and transverse colon (dashed circle). SMA, superior mesenteric artery.
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Angiography showed a patent superior mesenteric artery trunk; however, there was decreased arterial perfusion and absent venous return at the tributary of the ascending colon and hepatic flexure (Fig. 2).
(A) The resected colon specimen was observed to have a dark purple-colored mucosal surface (arrow) with hemorrhagic spots and marked mural thickening of the colon wall, particularly the right colon. In addition, there was a segmental stenosis over the hepatic flexure (arrowhead). (B) Hematoxylin and eosin staining revealed hyalinization, calcification, ossification and thrombosis of the mesenteric veins.
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There were numerous sclerotic veins or venules with hyalinization, calcification and areas of ossification in the intramural and extramural aspect of the colon, and a focal area of near-total occlusion of the venous lumen with ossification and thrombosis (Fig. 3).