Segmental Arterial Mediolysis and its Mimickers: A Case Report and Review of the Literature

Marine Najmaoui; Martina Pezzulo; Denis Franchimont; Frédéric Vandergheynst; Maxime Ilzkovitz

doi:10.12890/2023_004085

Segmental Arterial Mediolysis and its Mimickers: A Case Report and Review of the Literature

Eur J Case Rep Intern Med. 2023 Oct 16;10(11):004085. doi: 10.12890/2023_004085. eCollection 2023.

Authors

Marine Najmaoui¹, Martina Pezzulo², Denis Franchimont³, Frédéric Vandergheynst¹, Maxime Ilzkovitz¹

Affiliations

¹ Department of Internal Medicine, Hôpital Universitaire de Bruxelles (H.U.B.), Université Libre de Bruxelles (ULB), Brussels, Belgium.
² Department of Radiology, Hôpital Universitaire de Bruxelles (H.U.B.), Université Libre de Bruxelles (ULB), Brussels, Belgium.
³ Department of Gastroenterology, Hôpital Universitaire de Bruxelles (H.U.B.), Université Libre de Bruxelles (ULB), Brussels, Belgium.

Abstract

This case report addresses segmental arterial mediolysis (SAM), a rare non-inflammatory vasculopathy. A 51-year-old man presented at the emergency department for epigastric and left upper quadrant pain. He had a history of arterial hypertension and had recently received methylprednisolone for knee pain. Blood tests revealed elevated C-reactive protein levels at 40 mg/l and lactate dehydrogenase levels at 496 IU/ml. Abdominal computerized tomography showed arterial thickening, arterial dilatations, and dissections of the splenic and renal arteries, leading to organ ischemia. This case emphasizes the importance of considering SAM in cases of unexplained abdominal pain or suspected arteriopathy.

Learning points: Segmental arterial mediolysis (SAM) is a rare and underdiagnosed vasculopathy.SAM is a challenging diagnosis and should not be confused with vasculitis.SAM has a good prognosis with spontaneous resolution in most cases.

Keywords: Segmental arterial mediolysis; abdominal arteriopathy; arterial aneurysm; arterial dissection; vasculitis mimickers.