超音波検査技術

A man in his 80s presented to the emergency department due to sudden onset of epigastric pain. No remarkable abnormalities were observed in his vital signs, blood tests, and electrocardiograms. Ultrasonography (US) was performed to assess any gastrointestinal illness. Based on the complaint of acute onset and persistent pain localized to the epigastric region in the physical assessment during US, the visceral blood vessels were examined. The celiac artery was found to be dilated according to the low-intensity, heterogeneous full echo in the lumen of the blood vessels, suggesting a celiac artery dissection. Contrast-enhanced computed tomography was then performed, which showed localized aneurysm dilation of the celiac artery, intimal flap, and vascular lumen stenosis. Therefore, the patient was diagnosed with celiac artery dissection. A narrowed proximal portion of the celiac artery was observed, and the proper hepatic artery was imaged from the superior mesenteric artery via collateral circulation. Isolated celiac artery dissection is associated with diverse complications, including splenic infarction and retroperitoneal bleeding. It is also primarily associated with hypertension and smoking history, and its etiology is presumed to be idiopathic, traumatic, and median arcuate ligament syndrome. However, this patient had no hypertension or smoking history, and thus, his celiac artery dissection may be caused by median arcuate ligament syndrome. As gastrointestinal diseases were suspected, US was performed. However, celiac artery dissection may also be diagnosed by considering vascular diseases associated with acute visceral pain. A sonographer’s understanding of the importance of physical assessment before performing US will improve their diagnostic ability.