Clinical Presentation, Diagnosis, and Management of Mesenteric Vasculopathies in Pediatric Patients

Abstract

Mesenteric vasculopathies in pediatric patients pose a challenge for clinicians due to their nonspecific clinical presentations and the lack of reported clinical experience. Few cases have been reported in literature and knowledge of mesenteric vasculopathies has not been thoroughly understood. Diagnosis and management of mesenteric vasculopathies in children is heavily dependent on proper radiologic imaging. In this review, we attempt to consolidate information regarding the clinical presentation, diagnosis, and management of mesenteric vasculopathies of congenital malformations, genetic anomalies, vasculitis, and ischemic insults. Pediatric interventional radiology is providing a forefront of minimally invasive techniques for both diagnosis and treatment of various pathologies of the mesenteric vasculature.

Keywords

pediatric - mesenteric - vasculopathies - interventional radiology - vascular anomalies

^∗ Both authors contributed equally.

• References

• 1 Howard ER, Davenport M. Congenital extrahepatic portocaval shunts—the Abernethy malformation. J Pediatr Surg 1997; 32 (03) 494-497
• 2 Gallego C, Miralles M, Marín C, Muyor P, González G, García-Hidalgo E. Congenital hepatic shunts. Radiographics 2004; 24 (03) 755-772
• 3 Stringer MD. The clinical anatomy of congenital portosystemic venous shunts. Clin Anat 2008; 21 (02) 147-157
• 4 Morgan G, Superina R. Congenital absence of the portal vein: two cases and a proposed classification system for portosystemic vascular anomalies. J Pediatr Surg 1994; 29 (09) 1239-1241
• 5 Kwapisz L, Wells MM, AlJudaibi B. Abernethy malformation: congenital absence of the portal vein. Can J Gastroenterol Hepatol 2014; 28 (11) 587-588
• 6 Witjes CD, Ijzermans JN, Vonk Noordegraaf A, Tran TK. Management strategy after diagnosis of Abernethy malformation: a case report. J Med Case Rep 2012; 6: 167
• 7 Niwa T, Aida N, Tachibana K. , et al. Congenital absence of the portal vein: clinical and radiologic findings. J Comput Assist Tomogr 2002; 26 (05) 681-686
• 8 Mistinova J, Valacsai F, Varga I. Congenital absence of the portal vein—case report and a review of literature. Clin Anat 2010; 23 (07) 750-758
• 9 Donnelly LF, Adams DM, Bisset III GS. Vascular malformations and hemangiomas: a practical approach in a multidisciplinary clinic. AJR Am J Roentgenol 2000; 174 (03) 597-608
• 10 Passalacqua M, Lie KT, Yarmohammadi H. Congenital extrahepatic portosystemic shunt (Abernethy malformation) treated endovascularly with vascular plug shunt closure. Pediatr Surg Int 2012; 28 (01) 79-83
• 11 Lewis III VD, Meranze SG, McLean GK, O'Neill Jr JA, Berkowitz HD, Burke DR. The midaortic syndrome: diagnosis and treatment. Radiology 1988; 167 (01) 111-113
• 12 Rumman RK, Nickel C, Matsuda-Abedini M. , et al. Disease beyond the arch: a systematic review of middle aortic syndrome in childhood. Am J Hypertens 2015; 28 (07) 833-846
• 13 Levart TK, Klokocovnik T. Mid-aortic syndrome in a 3-year-old girl successfully treated by aorto-aortic grafting and renal artery implantation into the graft. Tex Heart Inst J 2012; 39 (05) 657-661
• 14 Delis KT, Gloviczki P. Middle aortic syndrome: from presentation to contemporary open surgical and endovascular treatment. Perspect Vasc Surg Endovasc Ther 2005; 17 (03) 187-203
• 15 Sethna CB, Kaplan BS, Cahill AM, Velazquez OC, Meyers KE. Idiopathic mid-aortic syndrome in children. Pediatr Nephrol 2008; 23 (07) 1135-1142
• 16 Sumboonnanonda A, Robinson BL, Gedroyc WM, Saxton HM, Reidy JF, Haycock GB. Middle aortic syndrome: clinical and radiological findings. Arch Dis Child 1992; 67 (04) 501-505
• 17 Orellana-Barrios MA, Rosales A, Karkoutly A, Meyerrose GE. Middle aortic syndrome: imaging and endovascular treatment. Tex Heart Inst J 2015; 42 (06) 588-589
• 18 Dunham GM, Ingraham CR, Maki JH, Vaidya SS. Finding the nidus: detection and workup of non-central nervous system arteriovenous malformations. Radiographics 2016; 36 (03) 891-903
• 19 Torabi M, Hosseinzadeh K, Federle MP. CT of nonneoplastic hepatic vascular and perfusion disorders. Radiographics 2008; 28 (07) 1967-1982
• 20 Di Lorenzo C, Colletti RB, Lehmann HP. , et al; AAP Subcommittee; NASPGHAN Committee on Chronic Abdominal Pain. Chronic abdominal pain in children: a technical report of the American Academy of Pediatrics and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 2005; 40 (03) 249-261
• 21 Aschenbach R, Basche S, Vogl TJ. Compression of the celiac trunk caused by median arcuate ligament in children and adolescent subjects: evaluation with contrast-enhanced MR angiography and comparison with Doppler US evaluation. J Vasc Interv Radiol 2011; 22 (04) 556-561
• 22 Scholbach T. Celiac artery compression syndrome in children, adolescents, and young adults: clinical and color duplex sonographic features in a series of 59 cases. J Ultrasound Med 2006; 25 (03) 299-305
• 23 Horton KM, Talamini MA, Fishman EK. Median arcuate ligament syndrome: evaluation with CT angiography. Radiographics 2005; 25 (05) 1177-1182
• 24 Fong JK, Poh AC, Tan AG, Taneja R. Imaging findings and clinical features of abdominal vascular compression syndromes. AJR Am J Roentgenol 2014; 203 (01) 29-36
• 25 Lamba R, Tanner DT, Sekhon S, McGahan JP, Corwin MT, Lall CG. Multidetector CT of vascular compression syndromes in the abdomen and pelvis. Radiographics 2014; 34 (01) 93-115
• 26 Joyce DD, Antiel RM, Oderich G. , et al. Pediatric median arcuate ligament syndrome: surgical outcomes and quality of life. J Laparoendosc Adv Surg Tech A 2014; 24 (02) 104-110
• 27 Said SM, Zarroug AE, Gloviczki P, Shields RC. Pediatric median arcuate ligament syndrome: first report of familial pattern and transperitoneal laparoscopic release. J Pediatr Surg 2010; 45 (12) e17-e20
• 28 Lin AE, Birch PH, Korf BR. , et al. Cardiovascular malformations and other cardiovascular abnormalities in neurofibromatosis 1. Am J Med Genet 2000; 95 (02) 108-117
• 29 Bargiela D, Verkerk MM, Wee I, Welman K, Ng E, Choong AMTL. The endovascular management of neurofibromatosis-associated aneurysms: a systematic review. Eur J Radiol 2018; 100: 66-75
• 30 Rahman Q, Naidu SG, Chong BW, Stone WM. Percutaneous embolization of an inferior mesenteric artery aneurysm in a patient with type IV Ehlers–Danlos syndrome. Vasc Endovascular Surg 2019; 53 (04) 343-347
• 31 Okada T, Frank M, Pellerin O. , et al. Embolization of life-threatening arterial rupture in patients with vascular Ehlers–Danlos syndrome. Cardiovasc Intervent Radiol 2014; 37 (01) 77-84
• 32 Yuan S, Ye Y, Chen D. , et al. Lupus mesenteric vasculitis: clinical features and associated factors for the recurrence and prognosis of disease. Semin Arthritis Rheum 2014; 43 (06) 759-766
• 33 Byun JY, Ha HK, Yu SY. , et al. CT features of systemic lupus erythematosus in patients with acute abdominal pain: emphasis on ischemic bowel disease. Radiology 1999; 211 (01) 203-209
• 34 Morishita KA, Rosendahl K, Brogan PA. Familial Takayasu arteritis—a pediatric case and a review of the literature. Pediatr Rheumatol Online J 2011; 9 (01) 6
• 35 Brunner J, Feldman BM, Tyrrell PN. , et al. Takayasu arteritis in children and adolescents. Rheumatology (Oxford) 2010; 49 (10) 1806-1814
• 36 Moriwaki R, Noda M, Yajima M, Sharma BK, Numano F. Clinical manifestations of Takayasu arteritis in India and Japan—new classification of angiographic findings. Angiology 1997; 48 (05) 369-379
• 37 Higaki R, Miyazaki A, Tajiri Y. , et al. Continuous infusion of lipo-prostaglandin E1 for Takayasu's arteritis with heart failure in an 11-month-old baby: a case report. J Med Case Rep 2018; 12 (01) 266
• 38 Cohen RD, Conn DL, Ilstrup DM. Clinical features, prognosis, and response to treatment in polyarteritis. Mayo Clin Proc 1980; 55 (03) 146-155
• 39 Stanson AW, Friese JL, Johnson CM. , et al. Polyarteritis nodosa: spectrum of angiographic findings. Radiographics 2001; 21 (01) 151-159
• 40 Vasbinder GBC, Nelemans PJ, Kessels AG. , et al; Renal Artery Diagnostic Imaging Study in Hypertension (RADISH) Study Group. Accuracy of computed tomographic angiography and magnetic resonance angiography for diagnosing renal artery stenosis. Ann Intern Med 2004; 141 (09) 674-682 , discussion 682
• 41 Eleftheriou D, Brogan PA. Therapeutic advances in the treatment of vasculitis. Pediatr Rheumatol Online J 2016; 14 (01) 26
• 42 Rowley AH, Shulman ST. Kawasaki syndrome. Clin Microbiol Rev 1998; 11 (03) 405-414
• 43 Spira D, Kötter I, Ernemann U. , et al. Imaging of primary and secondary inflammatory diseases involving large and medium-sized vessels and their potential mimics: a multitechnique approach. AJR Am J Roentgenol 2010; 194 (03) 848-856
• 44 Rowley AH, Gonzalez-Crussi F, Shulman ST. Kawasaki syndrome. Rev Infect Dis 1988; 10 (01) 1-15
• 45 Akikusa JD, Laxer RM, Friedman JN. Intestinal pseudoobstruction in Kawasaki disease. Pediatrics 2004; 113 (05) e504-e506
• 46 Jeican II, Ichim G, Gheban D. Intestinal ischemia in neonates and children. Clujul Med 2016; 89 (03) 347-351
• 47 Aidlen J, Anupindi SA, Jaramillo D, Doody DP. Malrotation with midgut volvulus: CT findings of bowel infarction. Pediatr Radiol 2005; 35 (05) 529-531
• 48 Beck R, Halberthal M, Zonis Z, Shoshani G, Hayari L, Bar-Joseph G. Abdominal compartment syndrome in children. Pediatr Crit Care Med 2001; 2 (01) 51-56
• 49 Dunning K, Mattei P. Burkitt lymphoma presenting as colonic ischemia and overwhelming sepsis. J Pediatr Surg 2007; 42 (08) E15-E17
• 50 Oldenburg WA, Lau LL, Rodenberg TJ, Edmonds HJ, Burger CD. Acute mesenteric ischemia: a clinical review. Arch Intern Med 2004; 164 (10) 1054-1062
• 51 Kumar S, Sarr MG, Kamath PS. Mesenteric venous thrombosis. N Engl J Med 2001; 345 (23) 1683-1688
• 52 Smerud MJ, Johnson CD, Stephens DH. Diagnosis of bowel infarction: a comparison of plain films and CT scans in 23 cases. AJR Am J Roentgenol 1990; 154 (01) 99-103
• 53 Schoots IG, Levi MM, Reekers JA, Lameris JS, van Gulik TM. Thrombolytic therapy for acute superior mesenteric artery occlusion. J Vasc Interv Radiol 2005; 16 (03) 317-329
• 54 Rahim S. Pocket Interventional Radiology. 1st ed. Philadelphia, PA: Wolters Kluwer; 2018