OVERLOOKED CHRONIC MESENTERIC VENOUS THROMBOSIS: AS A MIMICKER

Purpose:
Timely diagnosis and treatment of MVT is the main factor affecting the patients’ outcome. Given its non-specific clinical and laboratory findings, radiologic modalities are highly suggested to minimize the diagnosis delay. Missed mesenteric venous thrombosis may be lethal, but some cases recovered with residual stenosis of the SMV or its branches, leading to chronic abdominal pain evaluated by CT scan. In this presentation, we review the most common types of chronic MVT CT findings that imitate other differential diagnoses with the relatively same presentations and consequently interrupt the timely diagnosis and treatment.
Imaging Findings:
Several secondary findings could mimic other disease processes still masquerade underlying remote thrombosis and causing misdiagnosis and mismanagement. Crohn’s disease, bowel and mesenteric tumors, lymphoma, and mesenteric panniculitis may simulate by remote venous thrombosis on the CT scan. Obstruction, GI bleeding with unknown origin are other clinical presentations besides chronic abdominal pain.
Discussion:
To minimize the misdiagnosing, we recommend radiologists carefully follow all vessels’ entire course to detect the focal narrowing as far as the distal branches. Besides, collateral vessels in chronic MVT originate from the venous system; However, comb signs in crohn’s disease are prominent arteries. Although rare, we reviewed almost all different deceptive radiologic manifestations of chronic MVT, all of which could be ruled out through scrutinized following the collaterals and mesenteric vasculature. This point could minimize not only further invasive and costly investigations but also a presentation-to-treatment interval time, providing a more favorable outcome. Yet, our findings should be confirmed through further investigations on a larger sample size.
Conclusion:
Radiologists should be aware of similar conditions that chronic MVT could imitate their CT features. greater attention to mesenteric vasculature and collaterals in abdominal CT scans of patients with clinical suspicion for chronic MVT could minimize the misdiagnosis.