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Case Report | Radiology and Medical Imaging Sciences | Volume 15 Issue 6, June 2026 | Pages: 1672 - 1678 | India
Acute on a Quiet Background: CT Angiographic Diagnosis of Spontaneous Isolated Superior Mesenteric Artery Dissection with Proximal False-Lumen Thrombosis
Abstract: Spontaneous isolated dissection of the superior mesenteric artery (SISMAD) is the most frequently encountered visceral artery dissection, yet it remains an uncommon and often unsuspected cause of abdominal pain. Where it once surfaced mostly at autopsy, cross-sectional imaging now finds it in living, symptomatic patients, and the reported frequency has climbed accordingly[2,11]. We describe a 53-year-old man who presented with two months of insidious, food-aggravated periumbilical pain accompanied by anorexia and recent weight loss. Contrast-enhanced CT of the abdomen demonstrated an intimal flap arising 9.5 mm distal to the SMA origin and extending 7.5 cm caudally, with an eccentric, partially thrombosed false lumen of larger calibre compressing the true lumen by 70?80% to a residual diameter of roughly 3.8 mm. The dissection spared the ileocolic branches, although the mid-jejunal branches showed luminal irregularity and narrowing suggestive of hypoperfusion. No aortic dissection, frank bowel infarction, or aneurysmal rupture was present. The constellation corresponds to a Sakamoto type III lesion. Given haemodynamic stability and absence of transmural ischaemia, conservative management with blood-pressure control and antithrombotic therapy was pursued, with digital subtraction angiography and serial lactate held in reserve. This report sets out the CT angiographic signatures that secure the diagnosis and situates the imaging-based classification schemes that steer treatment.
Keywords: Superior mesenteric artery dissection, SISMAD, CT angiography, intimal flap, false lumen thrombosis, Sakamoto classification, mesenteric ischaemia, visceral artery dissection
How to Cite?: Dr. Utkarsh Rajput, Dr. Ganesh Avhad, Dr. Madan Manmohan, "Acute on a Quiet Background: CT Angiographic Diagnosis of Spontaneous Isolated Superior Mesenteric Artery Dissection with Proximal False-Lumen Thrombosis", Volume 15 Issue 6, June 2026, International Journal of Science and Research (IJSR), Pages: 1672-1678, https://www.ijsr.net/getabstract.php?paperid=SR26611191735, DOI: https://dx.doi.org/10.21275/SR26611191735