DOI: 10.12890/2023_003766

Reversible 'unstable' abdominal angina caused by ruptured plaque of the superior mesenteric artery: clinical and radiological correlations

Authors

  • Shaul Yaari Department of Medicine, Hadassah Hebrew University Hospital, Mount Scopus, Jerusalem, Israel
  • Nurith Hiller Department of Radiology, Hadassah Hebrew University Hospital, Mount Scopus, Jerusalem, Israel
  • Yacov Samet Department of Vascular Surgery, Shaare Zedek Medical Center, Jerusalem, Israel
  • Samuel Noam Heyman Department of Medicine, Hadassah Hebrew University Hospital, Mount Scopus, Jerusalem, Israel

heyman@cc.huji.ac.il

Keywords

Mesenteric ischemia, abdominal angina, atherosclerosis, unstable angina, superior mesenteric artery, atheromatous plaque

Abstract

Unstable angina, characteristic of coronary artery disease, is caused by in-situ clot formation complicating ruptured atheromatous plaque. Abdominal angina, however, usually reflects chronic mesenteric ischaemia, caused by multi-vessel stable plaques involving mesenteric arteries. Herein, we describe a patient with new-onset abdominal pain caused by a ruptured atheromatous plaque at the superior mesenteric root. The diagnosis was based on an evident reversible epigastric bruit and high-degree eccentric stenosis caused by a non-calcified atheroma. Symptoms and bruit resolved within 3 weeks on aspirin and statins with regression of the stenotic lesion. Although the condition is likely common, this is the first clear-cut report compatible with 'unstable' abdominal angina, resolved by conservative treatment.

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References

  1. Derrick JR, Pollard HS, Moore RM. The pattern of arteriosclerotic narrowing of the celiac and superior mesenteric arteries. Ann Surg 1959;149:684–689.
  2. Heyman SN, Leibowitz D, Mor-Yosef Levi I, Liberman A, Eisenkraft A, Alcalai R, et al. Hypoxia-adaptive response and remote ischemia preconditioning: a new hypoxia inducible factors era in clinical medicine. Acta Physiol (Oxf) 2016;216:395–406.
  3. Wong YL, Lautenschläger I, Hummitzsch L, Zitta K, Cossais F, Wedel T, et al. Effects of different ischemic preconditioning strategies on physiological and cellular mechanisms of intestinal ischemia/reperfusion injury: implication from an isolated perfused rat small intestine model. PLoS One 2021;16:e0256957.
  4. Sardar P, White CJ. Chronic mesenteric ischemia: diagnosis and management. Prog Cardiovasc Dis 2021;65:71–75.
  5. van Petersen AS, Kolkman JJ, Meerwaldt R, Huisman AB, van der Palen J, Zeebregts CJ, et al. Mesenteric stenosis, collaterals, and compensatory blood flow. J Vasc Surg 2014;60:111–119.
  6. Acosta S. Epidemiology of mesenteric vascular disease: clinical implications. Semin Vasc Surg 2010;23:4–8.
  7. Berman LG, Russo FR. Abdominal angina. N Engl J Med 1950;242:611–613.
  8. Fuster V, Badimon L, Badimon JJ, Chesebro JH. The pathogenesis of coronary artery disease and the acute coronary syndromes. N Engl J Med 1992;326:310–318.
  9. Sherman CT, Litvack F, Grundfest W, Lee M, Hickey A, Chaux A, et al. Coronary angioscopy in patients with unstable angina pectoris. N Engl J Med 1986;315:913–919.
  10. Wood P. Acute and subacute coronary insufficiency. Br Med J 1961;1(5242):1779–1782.

Published

2023-04-06

Issue

Vol. 10 No. 4 (2023)

Categories

How to Cite

1.
Yaari S, Hiller N, Samet Y, Heyman SN. Reversible ’unstable’ abdominal angina caused by ruptured plaque of the superior mesenteric artery: clinical and radiological correlations. EJCRIM [Internet]. 2023 Apr. 6 [cited 2026 Nov. 3];10(4). Available from: https://ejcrim.com/index.php/ejcrim/article/view/3766

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