Celiac dissection after blunt abdominal trauma complicated by acute hepatic failure: Case report and review of literature Chlodwig Kirchhoff, MD, Julia.

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Presentation transcript:

Celiac dissection after blunt abdominal trauma complicated by acute hepatic failure: Case report and review of literature Chlodwig Kirchhoff, MD, Julia Stegmaier, MD, Michael Krotz, MD, Elisabeth Muetzel (Rauch), MD, Wolf Mutschler, MD, Karl-Georg Kanz, MD, Bernhard Heindl, MD Journal of Vascular Surgery Volume 46, Issue 3, Pages 576-580 (September 2007) DOI: 10.1016/j.jvs.2007.04.041 Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 1 Arterial phase computed tomography scan image of the abdomen performed on day 5 after trauma. For side orientation, the liver (L) and spleen (S) are marked. The image shows the dissection flap (DF) within the celiac artery, originating from the aorta (A). The dissection is characterized by the presence of an intimal flap with concomitant wall hematoma. Journal of Vascular Surgery 2007 46, 576-580DOI: (10.1016/j.jvs.2007.04.041) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 2 a, Follow-up abdominal native computed tomography (CT) scan on day 7 after trauma depicts complete thrombotic obliteration of the hepatic artery, originating from the dissection of the celiac artery (CD, white arrows). The liver (L) presents with large multilocular perfusion deficits (PD) within the right liver lobe (white arrows). b, A CT scan of the abdmen on the same time point as (a) shows further perfusion defects within the liver (PD, white arrows). Journal of Vascular Surgery 2007 46, 576-580DOI: (10.1016/j.jvs.2007.04.041) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 3 a, Follow-up abdominal excretion phase computed tomography (CT) scan on day 7 after trauma shows the superior mesenteric artery (SMA, white arrow), showing inconspicuous findings. L, Liver; S, spleen. b, A CT scan of the abdomen on the same time point in portal venous phase shows the portal vein (PV, white arrow), also showing patency and normal flow. Journal of Vascular Surgery 2007 46, 576-580DOI: (10.1016/j.jvs.2007.04.041) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 4 This macroscopic view shows the ostium of the superior mesenteric artery (OSMA) on the left side and the ostium of the celiac artery (OCA). Within the region of the celiac trunk, the thrombotic conclusion of the dissection of the celiac artery (CD, white arrows) is visible. On the right side, the true lumen of the celiac artery (CAL) is shown. Journal of Vascular Surgery 2007 46, 576-580DOI: (10.1016/j.jvs.2007.04.041) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 5 A section of the celiac artery (original magnification ×100, van Gieson staining), shows dissection (black arrows) with numerous erythrocytes and fibrin (X) within the external elastic layer. Journal of Vascular Surgery 2007 46, 576-580DOI: (10.1016/j.jvs.2007.04.041) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions