PMC7550828_01
A CT Angiography of chest abdomen and pelvis done on presentation showing (A) Axial section distal to the origin of SMA showing partial occlusion by embolus (red arrow in the three views), (B) Axial section showing the splenic and left kidney infarcts, (C) Coronal section showing the SMA, (D) Sagittal section showing the SMA and a partially occlusive thrombus in the descending thoracic aorta.
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Angiography (Fig. 1) which showed partial occlusive thrombi in the descending thoracic aorta and the superior mesenteric artery (SMA). Also, there was an occlusive thrombus in the splenic artery with the spleen almost replaced by a few large hypodense areas representing splenic infarction.
SMA angiograms done during the endovascular procedure, (A) at the beginning showing a partial occlusion of the SMA and a partial perfusion of the bowel, and (B) at the end of the procedure showing the revascularization and the opening of some closed branches.
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SMA showed an embolus distal to the origin of the middle colic artery causing severe stenosis of the SMA and occlusion of some jejunal branches (Fig. 2A). Suction embolectomy was performed with the extraction of thrombotic material followed by intra-arterial injection of 4000 IU of The final angiogram showed opening of the occluded branches and better flow in the artery (Fig. 2B). The patient was monitored in the ICU where he had a smooth postoperative course.
A CT Angiography 10 months later showing, (A) patent SMA, (B) atrophy of the spleen due to the previous infarction.
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A CT Angiography was done 10 months later (Fig. 3) showed patency of the SMA, atrophy of the spleen due to the previous infarction, and right renal hydroureteronephrosis due to his kidney stone problem for which he was admitted to the urology department.