Acute Mesenteric Ischemia

A review of Dr. Werner and Dr. Martinez's discussion of the key Dx and Rx features of acute mesenteric ischemia.

Jeremy W. -

How do you reliably order AND get adequate image quality for both the arterial AND venous side of mesenteric circulation?

Because when you have the clinical scenario for ischemia symptoms, sometimes the images illuminate the intravascular space on the arterial side, at the expense of the venous opacification--or vice versa (the contrast almost or completely traversed the arterial side, and is now opacifying the venous side alone).

Without the contrast filling the vessel, you won't see the radiographic contrast 'exclusion', typical of a space-occupying clot.

Whitney J. -

Thanks for the question Jeremy! Remember that the clinical presentations differ so using that to guide likelihood is important. If you really are stumped and need to consider both you can call the radiologist and discuss your suspicions/what you're looking for to ensure they run a biphasic study this way you'll get the arterial and portal venous phase

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