Acute aortic occlusions (AAOs) are rare vascular emergencies associated with high morbidity and mortality. Presenting signs and symptoms vary but typically involve the lower extremities and include mottled skin with diminished pedal pulses, paresis, and severe pain. Prompt recognition and imaging are necessary to prevent rapid deterioration, which can lead to loss of limb or death. Treatment includes surgical or endovascular interventions based on patient-associated risk factors and clot location. We present a 76-year-old female who arrived at the emergency department with an AAO involving the infrarenal abdominal aorta and bilateral common iliac arteries. Efficient physical examination and utilization of computed tomography with angiography of the abdomen and pelvis allowed for the appropriate recognition of the AAO and subsequent successful surgical embolectomy. This case report underscores the importance of an expeditious clinical and radiographic evaluation in patients presenting with lower extremity pain and weakness.

A renal infarction occurs when kidney\'s arterial blood supply is compromised, causing parenchymal necrosis and loss of function. It is a relatively uncommon complication and its treatment is time-dependent. We present a case where a female patient with a history of bilateral aortic-iliac stenting over 10 years before presented with chest pain, palpitations, and dyspnea associated with hypertension. The patient progressed with an acute worsening of renal function and anuria, with an urgent need for renal replacement therapy. The abdominal CT angiography confirmed a complete chronic stent thrombosis and a recent occlusion of the right renal artery causing an acute renal infarction; however, this exam was performed more than 72 hours after admission. There was no longer indication for reperfusion therapy, taking into account the time course. This case reinforces the importance of a thorough clinical history and awareness of risk factors to raise the suspicion of renal infarction that should lead to an early contrast-enhanced CT scan so that adequate therapy can be performed.

Median arcuate ligament syndrome (MALS) is a rare and controversial vascular compression syndrome. In this condition, the median arcuate ligament compresses the celiac artery, resulting in symptoms such as postprandial abdominal pain, vomiting, and weight loss. Its diagnosis is based on clinical findings in conjunction with supporting radiological features such as elevated flow velocities on Doppler ultrasound and focal indentation of the proximal celiac artery with the typical \'hooked\' or \'J\'-shaped appearance on conventional angiography or computed tomography angiography (CTA). Herein is the case of a 44-year-old female who presented with early satiety, postprandial abdominal pain, vomiting, and weight loss. A computed tomography mesenteric angiogram (CTMA) showed thickening of the median arcuate ligament with a hooked appearance of the celiac artery and thrombosis of the mid to distal superior mesenteric artery with associated ischemia of a short segment of the jejunum. Subsequent Doppler ultrasound demonstrated elevated peak systolic velocities within the celiac artery over the compressed segment, which varied with respiration (end-inspiration: 234.3 cm/s and end-expiration: 373.5 cm/s).

A rectus sheath hematoma, which is mostly encountered due to abdominal traumas or anticoagulant use, can be challenging, and a delayed diagnosis may lead to hypovolemic shock and even death. In this study, we aimed to present the management of a case of rectus sheath hematoma that developed in a patient who was hospitalized and under coronavirus disease 2019 (COVID-19) treatment. A 70-year-old female patient was admitted to the intensive care unit (ICU) due to respiratory failure and developed a sudden onset of tachycardia and hypotension. The patient was then diagnosed with a rectus sheath hematoma and after ensuring hemodynamic stability she was treated with angiographic embolization. Following the treatment, the patient remained hemodynamically stable and a control computed tomography (CT) revealed regression in the hematoma. Rectus sheath hematomas especially accompanied by additional comorbidities or aggressive surgical interventions may result in high mortality rates in the early period. It should also be kept in mind that during the COVID-19 pandemic, which has affected the world in the last two years, rectus sheath hematomas may be the underlying cause of sudden hypotension and abdominal distension, and it should not be forgotten that angiographic embolization performed by experienced interventional radiologists is the mainstay of treatment in cases where hemodynamic stability can\'t be achieved.

Renal arteries are the main blood supply to the kidneys. They originate from the abdominal aorta at the level of the first and second lumbar vertebrae. However, variations in their origin are common. Therefore, studying renal arteries before any surgical intervention such as renal transplant surgery, conservative or radical renal surgeries, renal trauma, and others, is crucial to avoid undesirable avoidable complications or morbidities. Herein, we report a case of an isolated right supradiaphragmatic renal artery that was discovered incidentally in a 66-year-old female patient with normal blood pressure.

OBJECTIVE: To investigate whether contrast-enhancement-boost (CE-boost) in combination with hybrid iterative reconstruction (Hybrid IR, also named HIR [AIDR 3D, adaptive iterative dose reduction three dimensional]) and model-based iterative reconstruction (MBIR [FIRST, forward projected model-based IR solution]) algorithms can improve the image quality of abdominal CT angiography (CTA).
METHODS: This retrospective study included 50 patients who underwent abdominal CTA. Both arterial and portal phases were reconstructed using three different algorithms [filtered-back projection (FBP), AIDR 3D, and FIRST] separately. CE-boost was performed additionally to generate AIDR 3D-boost and FIRST-boost images. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the arteries and portal system were compared among the five datasets (FBP, AIDR 3D, FIRST, AIDR 3D-boost, FIRST-boost). In subjective analyses, two radiologists independently ordered images (5, best; 1, worst) based on the visual image quality of distal arterial or portal venous branches. The Friedman and the Dunn-Bonferroni post-hoc tests were used for statistical analysis.
RESULTS: FIRST-boost arterial and portal images had the lowest noise compared with FBP, AIDR 3D, FIRST, and AIDR 3D-boost images (all P < 0.05), and significantly higher SNR and CNR than FBP, AIDR 3D, and FIRST images (all P < 0.05). AIDR 3D-boost images showed lower noise, and higher SNR and CNR than FBP and AIDR 3D images (all P < 0.05). FIRST-boost images had higher subjective grading scores than FBP, AIDR 3D, and AIDR 3D-boost images (all P < 0.05).
CONCLUSIONS: The postprocessing technique CE-boost can improve the image quality of abdominal CTA images. MBIR in combination with CE-boost (FIRST-boost) images had the best image quality compared with the other four image datasets.

Visceral artery pseudoaneurysms are rare but potentially life-threatening. Among visceral artery pseudoaneurysm (VAPA), the superior mesenteric artery (SMA) pseudoaneurysm is the rarest type. VAPAs are usually related with infection, inflammatory disease, trauma, or arises as a postoperative complication. Early diagnosis and endovascular or surgical intervention are key in lowering the risk of intestinal infarction and death due to potentially fatal hemorrhage. A 49-year-old man presented with cough, shortness of breath, weight loss, and an incidental finding of spontaneous SMA pseudoaneurysm with localized bleed on CT angiography. An urgent endovascular embolization was performed of the pseudoaneurysm, with an adequate outcome and recovery. SMA pseudoaneurysms associated with infective endocarditis are rare but carry a high risk of rupture and related morbidity and mortality. Direct oral anticoagulants like apixaban (Eliquis) have also been reported to cause pseudoaneurysm formation by slow and constant bleeding, which may have contributed here as a cause of pseudoaneurysm along with infective endocarditis, which was diagnosed later after endovascular embolization. The treatment can be either an endovascular, endoscopic, or open surgical approach.

OBJECTIVE: To evaluate the image quality and ability to delineate the small visceral arteries of high-resolution (HR) abdominal CT angiography (CTA) using an ultra-high-resolution computed tomography (UHR CT) scanner.
METHODS: Thirty-seven patients were enrolled who underwent abdominal CTA using a UHR CT scanner. The images were reconstructed with a matrix of 1024 × 1024 and 0.25 mm thickness for HR CTA and with a matrix of 512 × 512 and 0.5 mm thickness for normal resolution (NR) CTA. Maximum CT value, image quality, and delineation of the small arteries were compared between HR CTA and NR CTA.
RESULTS: HR CTA showed significantly higher maximum CT value, higher image quality, and better delineation of the small arteries than did NR CTA (P < .005).
CONCLUSIONS: HR CTA using a UHR CT scanner showed higher image quality than NR CTA and enhanced the delineation of visceral arteries.

OBJECTIVE: This study aimed to compare the quality of abdominal CT angiography (CTA) images obtained using conventional reconstruction algorithms with those obtained using a novel iterative algorithm (forward projected model-based iterative reconstruction solution, FIRST) for evaluating arteries in the abdomen.
METHODS: Abdominal CTA images from 60 patients (M:F = 27:33; mean age, 62.4 ± 16.7 years) were reconstructed using three algorithms - filtered back projection (FBP), adaptive iterative dose reduction 3D (AIDR 3D), and FIRST. Image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) in the abdominal aorta, celiac trunk, superior mesenteric, renal, and right hepatic arteries were objectively evaluated via region-of-interest analysis and compared using the one-way analysis of variance test. Two radiologists independently scored and selected the best (score 3), second best (score 2), and the worst (score 1) images based on the visual image quality of peripheral arteries. Wilcoxon signed rank test was used for comparing image quality scores.
RESULTS: FIRST and AIDR 3D significantly reduced image noise compared with FBP (P < 0.001). SNR and CNR were significantly higher with AIDR 3D and FIRST than with FBP reconstruction (P < 0.001), with FIRST displaying the highest CNR (14.31 ± 4.17) for the right hepatic artery than the other two methods (P < 0.05). Both radiologists scored FIRST images as having the best image quality among the three methods for peripheral abdominal artery evaluation (3.0 ± 0.0, P < 0.001).
CONCLUSIONS: FIRST reconstruction yielded superior abdominal CTA images as compared with FBP or AIDR 3D reconstruction.

BACKGROUND: Post-pancreaticoduodenectomy hemorrhage is mostly due to the gastroduodenal artery stump erosion. The diagnosis of arterial bleeding is done by digestive endoscopy, selective angiography or video capsule endoscopy. On failure of etiological research, surgery is the last resort despite its technical difficulties.
METHODS: A 63 years-old woman was admitted in surgery, nine months after cephalic pancreaticoduodenectomy for a pain of the right hypochondria combined with a pneumoperitoneum, after a 3rd episode of hemorrhage. Exploratory laparotomy is performed after a third hemorrhagic episode and failure of etiological research. Bleeding from the gastroduodenal artery stump was discovered and successfully treated.
CONCLUSIONS: Post-pancreaticoduodenectomy hemorrhage can occur very late. In these cases, a secondary arterial erosion obstructed by left hemi-liver should not be excluded. In these cases, despite the technical risks, surgery is required.
CONCLUSIONS: The failure of the means used for diagnostic must lead to the surgery right away, despite operating risk.