Clinical characteristics and misdiagnosis of spontaneous isolated superior mesenteric artery dissection

doi:10.1186/s12872-022-02676-9

科研成果详情

题名	Clinical characteristics and misdiagnosis of spontaneous isolated superior mesenteric artery dissection
作者	Lei, Yuanli1; Liu, Jinying1; Lin, Yi 2; Li, Huiping3; Song, Wenxing1; Li, Zhangping 1; Huang, Weijia1; Chen, Shouquan1
发表日期	2022-05-25
发表期刊	BMC CARDIOVASCULAR DISORDERS 影响因子和分区
语种	英语
原始文献类型	Article
关键词	Spontaneous isolated superior mesenteric artery dissection Clinical characteristics Abdominal pain Misdiagnosis
其他关键词	FOLLOW-UP ; MANAGEMENT ; ANGLE ; AORTA
摘要	Background Spontaneous isolated superior mesenteric artery (SMA) dissection (SISMAD) is a rare disease with a potentially fatal pathology. Due to the lack of specificity of clinical characteristics and laboratory tests, misdiagnosis and missed diagnosis are often reported. Therefore, the aim of this study was to investigate the clinical characteristics and misdiagnosis of SISMAD. Methods In a registry study from January 2013 to December 2020, 110 patients with SISMAD admitted to the First Affiliated Hospital of Wenzhou Medical University were enrolled. Descriptive methods were used to analyse clinical characteristics, laboratory data, diagnostic method or proof, misdiagnosed cases, plain computed tomography (CT) findings and dissection features. To study the relationship between dissection features and treatment modality, the selected patients were classified into the conservative group (n = 71) and the non-conservative group (n = 39). The Chi-square test and Student's t-test were used to compare the conservative and non-conservative groups. Results One hundred ten patients with SISMAD, including 100 (90.9%) males and 10 (9.1%) females, with a mean age of 52.4 +/- 7.6 years, were enrolled in the study. Relevant associated comorbidities included a history of hypertension in 43 cases (39.1%), smoking in 46 cases (41.8%), and alcohol consumption in 34 cases (30.9%). One hundred four patients (94.5%) presented with abdominal pain. Abnormalities in the C-reactive protein lever, white blood cells count and D-dimer lever were the 3 most common abnormal findings. There were 32 misdiagnosis or missed diagnosis. Fourteen cases were misdiagnosed because of insufficient awareness. Twelve cases were misdiagnosed because of disease features. Twenty cases were misdiagnosed as SMA embolism. Among them, There were 15 cases of Yun type IIb SISMAD. Sixty-six patients underwent plain CT. The maximum SMA diameter was 12.1 (11.3-13.1) mm, and the maximum SMA diameter was located on the left renal vein (LRV) plane in 68.2% of cases. Dissection features observed on contrast-enhanced CT (CECT), CT angiography (CTA), or digital subtraction angiography (DSA) showed that there were 70 cases (63.6%) of Yun type IIb SISMAD, the maximum SMA diameter was 13.0 +/- 2.4 mm, the location of the maximum SMA diameter was on the LRV plane in 64.5% of cases, and 7.3% of cases were complicated with intestinal obstruction, including bowel necrosis in 3.6% of cases. There were differences between the conservative group and non-conservative groups in the residual true lumen diameter or degree of true lumen stenosis and the presence of intestinal obstruction or bowel necrosis (all P < 0.05). Conclusion For SISMAD, misdiagnosis and missed diagnosis were usually caused by insufficient awareness and disease features. SISMAD should be considered in the differential diagnosis of patients presenting with unexplained abdominal pain, especially males, patients in the 5th decade of life, patients with hypertension, and patients with an enlarged SMA diameter or a maximum SMA diameter located on the LRV plane on plain CT. Mesenteric CTA or CECT should be recommended for the investigation of these conditions.
资助项目	Clinical Scientific Research Fund of Zhejiang Medical Association [2021ZYC-A73]
出版者	BMC
出版地	LONDON
ISSN	1471-2261
卷号	22 期号:1 页码:239
DOI	10.1186/s12872-022-02676-9
页数	12
WOS类目	Cardiac & Cardiovascular Systems
WOS研究方向	Cardiovascular System & Cardiology
WOS记录号	WOS:000799804500001
收录类别	SCIE ; SCOPUS ; PUBMED
URL	查看原文
Pubmed记录号	35610570
Scopus记录号	2-s2.0-85130728220
通讯作者地址	[Chen, Shouquan]Department of Emergency Medicine,The First Affiliated Hospital of Wenzhou Medical University,Zhejiang,Wenzhou,325000,China
scopus学科分类	Cardiology and Cardiovascular Medicine
引用统计	被引频次[WOS]：0 [WOS记录] [WOS相关记录]
文献类型	期刊论文
条目标识符	https://kms.wmu.edu.cn/handle/3ETUA0LF/148311
专题	第一临床医学院（信息与工程学院）、附属第一医院_急诊医学附属第一医院_消化内科第一临床医学院（信息与工程学院）、附属第一医院_影像医学与核医学_放射科
通讯作者	Chen, Shouquan
作者单位	1.Department of Emergency Medicine,The First Affiliated Hospital of Wenzhou Medical University,Zhejiang,Wenzhou,325000,China; 2.Department of Radiology,The First Affiliated Hospital of Wenzhou Medical University,Zhejiang,Wenzhou,325000,China; 3.Department of Gastroenterology,The First Affiliated Hospital of Wenzhou Medical University,Zhejiang,Wenzhou,325000,China
第一作者单位	附属第一医院; 第一临床医学院（信息与工程学院）、附属第一医院; 急诊医学
通讯作者单位	附属第一医院; 第一临床医学院（信息与工程学院）、附属第一医院; 急诊医学
第一作者的第一单位	附属第一医院
推荐引用方式 GB/T 7714	Lei, Yuanli,Liu, Jinying,Lin, Yi,et al. Clinical characteristics and misdiagnosis of spontaneous isolated superior mesenteric artery dissection[J]. BMC CARDIOVASCULAR DISORDERS,2022,22(1):239.
APA	Lei, Yuanli., Liu, Jinying., Lin, Yi., Li, Huiping., Song, Wenxing., ... & Chen, Shouquan. (2022). Clinical characteristics and misdiagnosis of spontaneous isolated superior mesenteric artery dissection. BMC CARDIOVASCULAR DISORDERS, 22(1), 239.
MLA	Lei, Yuanli,et al."Clinical characteristics and misdiagnosis of spontaneous isolated superior mesenteric artery dissection".BMC CARDIOVASCULAR DISORDERS 22.1(2022):239.