Color Doppler sonographic diagnosis of dissecting aneurysm of the superior mesenteric artery.

We report a case of dissecting aneurysm of the superior mesenteric artery (SMA) diagnosed on gray-scale and color Doppler sonography and confirmed on angiography. Spontaneous dissection of the SMA is rare, and there are few reported cases of the color Doppler sonographic findings. Gray-scale sonography revealed an aneurysmal dilatation of the SMA 3-4 cm from the SMA's origin, with an echogenic linear membrane (an intimal flap) within the aneurysm. Color Doppler sonography showed color flow within the aneurysm and showed that the intimal flap separated the aneurysm into 2 lumina. Spectral analysis revealed anterograde flow in the anterior (ie, true) lumen and retrograde flow in the posterior (ie, false) lumen.

Magnetic resonance angiography.

The field of MRA has progressed to a stage at which several clinical applications are of obvious value, including the diagnosis of cerebral aneurysms, venous disorders and disease of the carotid bifurcation. Additionally spin echo images are useful in studying the parenchyma and this together with MRA works to be an excellent diagnostic package in the presurgical workup of patients with cerebral vascular abnormalities. With further technical improvements, it seems likely that important applications of MRA will also be found in the diagnosis of peripheral artery disease, stenosis of the renal artery and ischemic heart disease. With the advent of fast imaging techniques like echoplanar imaging, the ability image the coronary and renal arteries accurately seems possible in the near future. At present, however the lack of optimal spatial resolution and the presence of flow artifacts precludes the use of this technique for imaging the vasculature with an accuracy comparable with conventional angiography. The advent for contrast 3-D CT angiography has resulted in a technique of studying the intracranial vessels immediately after assessing for the presence of subarachnoid hemorrhage. It is superior to MRA in demonstrating the actively filling and thrombused portions of giant, partially thrombused aneurysms and in planning the surgical approach in relation to bony landmarks. Though there are daunting obstacles, with continuous ongoing clinical research and the added inputs from a dramatically changing computer technology, MRA is all set to be an imaging study of great promise that may eventually replace diagnostic catheter angiography in most clinical situations.

Necrotising arteritis in amoebic colitis.

Massive intestinal haemorrhage rarely occurs in amoebic colitis. We report a case of caecal amoebic ulcer in a 61 year old diabetic male who presented with massive lower intestinal haemorrhage requiring blood transfusion and emergency surgical intervention. Histologically, trophozoites of Entamoeba histolytica were seen invading the wall of the submucosal arteries, causing necrotising arteritis. Rupture of a necrosed artery probably caused massive haemorrhage.

Percutaneous transcatheter steel-coil embolization of a large proximal post-traumatic superior mesenteric arteriovenous fistula.

Arteriovenous fistulae affecting the proximal portions of the superior mesenteric vessels are extremely rare. We are reporting one such fistula which occurred in a young male as a sequel to a stab in the epigastrium. The arteriovenous fistula was successfully treated by percutaneous steel coil embolization.