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Image of the Month—Quiz Case FREE

James Hamilton Black III, MD
[+] Author Affiliations

Author Affiliation:Department of Surgery, Johns Hopkins University, Baltimore, Maryland.


Section Editor: Grace S. Rozycki, MD


Arch Surg. 2007;142(8):797. doi:10.1001/archsurg.142.8.797.
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Published online

A 68-year-old man with a history of dyslipidemia and an elevated Lp(a) lipoprotein level developed acute abdominal pain and had tenderness to deep palpation on the right side of his abdomen. A computed tomographic scan demonstrated thickening of the ascending colon consistent with ischemic colitis. Hydration and antibiotic administration rapidly relieved his pain. Subsequent duplex imaging of the superior mesenteric artery revealed poststenotic turbulence and elevated peak velocities were noted. He was referred for angiography (Figure).

Place holder to copy figure label and caption
Figure.

Diagnostic aortography in a lateral projection revealed 90% to 95% stenosis appreciated at the origin of the celiac axis and the superior mesenteric artery (SMA). The inferior mesenteric artery was occluded. Balloon-expandable 8 × 18-mm stents were deployed in both vessels. The celiac axis stent was dilated to 10 mm to improve a residual stenosis. The patient recovered well and was discharged the next day, tolerating a regular diet and pain free. A, Before stents. B, After stents.

Graphic Jump Location

WHAT IS THE DIAGNOSIS?

A. Takayasu arteritis

B. Median arcuate ligament syndrome

C. Visceral aortic atherosclerosis

D. Fibromuscular dysplasia

Figures

Place holder to copy figure label and caption
Figure.

Diagnostic aortography in a lateral projection revealed 90% to 95% stenosis appreciated at the origin of the celiac axis and the superior mesenteric artery (SMA). The inferior mesenteric artery was occluded. Balloon-expandable 8 × 18-mm stents were deployed in both vessels. The celiac axis stent was dilated to 10 mm to improve a residual stenosis. The patient recovered well and was discharged the next day, tolerating a regular diet and pain free. A, Before stents. B, After stents.

Graphic Jump Location

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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