Giant cell arteritis manifesting as mesenteric ischemia

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Giant cell arteritis manifesting as mesenteric ischemia David Clay Evans, BS, Michael P. Murphy, MD, Jeffrey H. Lawson, MD, PhD Journal of Vascular Surgery Volume 42, Issue 5, Pages 1019-1022 (November 2005) DOI: 10.1016/j.jvs.2005.07.004 Copyright © 2005 The Society for Vascular Surgery Terms and Conditions

Fig 1 Anterior (A) and lateral (B) views of selective injections of the superior mesenteric artery (SMA) demonstrate a long segment of proximal SMA stenosis. C, Anterior view of selective injection of the celiac artery, with severe ostial narrowing. D, Stenosis of the SMA (arrowhead) is also visualized in this lateral aortogram. Focal narrowing of the proximal celiac artery with poststenotic dilatation and significant narrowing of the proximal SMA are visible in these close-ups of (E) abdominal and pelvic computed tomography angiography and (F) magnetic resonance angiography (MRA). G, MRA obtained using cardiac MRI pulse sequences reveals a proximal focal severe 90% stenosis of the SMA approximately 1 cm after the takeoff from the aorta and severe narrowing/subtotal occlusion at the branch point of the colic arteries approximately 7 cm after the origin of the SMA. Stenosis of the celiac artery is again visible. Subsequent to the proximal narrowing, the celiac trunk and its major branches (splenic artery, common hepatic artery) are widely patent and without significant stenosis. The inferior mesenteric artery has mild narrowing at its origin and a 70% stenosis approximately 6 cm after the takeoff from the aorta. Journal of Vascular Surgery 2005 42, 1019-1022DOI: (10.1016/j.jvs.2005.07.004) Copyright © 2005 The Society for Vascular Surgery Terms and Conditions

Fig 2 A, Masson staining of temporal artery biopsy cross-section (×4 original magnification) reveals mild scarring of the media and organized thrombus with recanalization. B, Hematoxylin and eosin staining of temporal artery biopsy cross section (×20 original magnification) reveals signs of chronic inflammation, granulomatous change, and multiple giant cells. An elastic stain (not shown) highlights the internal elastic lamina, which demonstrates loss and fragmentation. Journal of Vascular Surgery 2005 42, 1019-1022DOI: (10.1016/j.jvs.2005.07.004) Copyright © 2005 The Society for Vascular Surgery Terms and Conditions

Fig 3 Follow-up MRA obtained 21 months after initial presentation demonstrates that the SMA is now grossly normal in appearance, with no evidence of stenosis. The celiac artery still shows unchanged focal 70% stenosis and poststenotic dilatation. The inferior mesenteric artery is also now patent, with no evidence for stenosis (not visible in this view). Journal of Vascular Surgery 2005 42, 1019-1022DOI: (10.1016/j.jvs.2005.07.004) Copyright © 2005 The Society for Vascular Surgery Terms and Conditions