Zusammenfassung
Trotz Fortschritten in der Diagnostik und Therapie bleibt die akute mesenteriale Ischämie eine lebensbedrohliche Situation. Die Minderdurchblutung des Darms erfordert ein rasches Handeln, die korrekte Diagnosestellung ist jedoch aufgrund der unspezifischen klinischen Präsentation oft schwierig. Dieser Beitrag liefert einen Überblick zu Ätiologie, bildmorphologischer Präsentation und (seltenen) Differenzialdiagnosen der mesenterialen Ischämie.
Abstract
Despite diagnostic and therapeutic improvement over the past years, acute mesenteric ischaemia remains a life-threatening state due to decreased bowel perfusion necessitating immediate management with reported mortality rates of 50 – 90%. Highest prevalence is seen in the elderly population, where comorbidities negatively influence the mortality rate. Acute mesenteric ischaemia is caused by occlusive or non-occlusive conditions. Arterial embolism accounts for the majority of all cases with 40 – 50%, followed by arterial thrombosis (20 – 30%) and non-occlusive acute mesenteric ischaemia (NOMI) (20 – 30%). Mesenteric and portal venous thrombosis (5 – 10%) are less frequent. In terms of diagnosis, CT has become the first line imaging technique replacing angiography. However, clinical symptoms, laboratory presentation and imaging findings are often unspecific, so that they may simulate other intestinal diseases. Early diagnosis is but essential for patientsʼ prognosis. There exist numerous differential diagnoses, among which a review on common imaging manifestations and a number of rare findings are presented in this paper. The recognition of characteristic imaging appearances and uncommon differential diagnoses is essential for accurate interpretation and timely management of this acute condition.
Schlüsselwörter
mesenteriale Ischämie - vaskuläre Okklusion - nicht okklusive mesenteriale Ischämie (NOMI) - Computertomografie (CT)
Key words
mesenteric ischaemia - vascular occlusion - non-occlusive mesenteric ischaemia (NOMI) - computed tomography (CT)
