Spontaneous Isolated Celiac Artery Dissection With Subtle Non‐Contrast CT Findings

A 51‐year‐old man presented to the emergency department with severe epigastric pain that had begun abruptly after breakfast on the day of presentation. The pain intensity was approximately 8/10 and remained persistent without complete relief or fluctuation. No position alleviated the pain, and walking did not clearly exacerbate it. He had visited a clinic before presentation and had been prescribed medication, but his symptoms did not improve. He had not eaten since breakfast. His medical history was significant for hypertension, and he was a current smoker.

On arrival, he was alert, ambulatory, and hemodynamically stable. His blood pressure was 153/100 mmHg, pulse rate 68 beats/min, respiratory rate 18 breaths/min, temperature 36.5°C, and oxygen saturation 99% on room air. Physical examination revealed only mild epigastric tenderness without guarding or rebound tenderness. Laboratory tests, including a complete blood count, serum lactate, and D‐dimer, were unremarkable.

A non‐contrast computed tomography (CT) scan of the abdomen showed subtle increased attenuation of the fat surrounding the celiac artery, with slight hazy soft‐tissue density around the vessel (Figure 1). Given the abrupt onset of severe pain, the discrepancy between symptom severity and physical findings, and the subtle perivascular abnormality on non‐contrast CT, vascular pathology was suspected. Contrast‐enhanced CT subsequently demonstrated an intimal flap with an eccentric mural thrombus in the celiac artery, consistent with spontaneous isolated celiac artery dissection (Figure 2), without evidence of organ infarction or bowel ischemia.

FIGURE 1.

Non‐contrast CT showing subtle increased attenuation of the fat and hazy soft‐tissue density surrounding the celiac artery.

FIGURE 2.

Contrast‐enhanced CT demonstrating an intimal flap with an eccentric mural thrombus in the celiac artery, consistent with celiac artery dissection (arrow).

The patient was managed conservatively with strict blood pressure control and analgesia. His symptoms gradually improved, and he was discharged without complications.

Spontaneous isolated celiac artery dissection is rare and frequently underrecognized, and recent series suggest that an increasing number of cases are detected incidentally with the growing use of abdominal CT [1]. Clinical presentations are often nonspecific, including abdominal pain, back pain, and nausea or vomiting, and initial laboratory findings may be unremarkable [1, 2]. Because findings on non‐contrast CT can be subtle, the condition may be misattributed to more common causes of acute abdominal pain, including gastrointestinal disease, biliary disease, pancreatitis, or other vascular disorders [2, 3]. It may also mimic renal colic [2]. Contrast‐enhanced CT or CT angiography is essential for confirming the diagnosis and assessing associated complications [1, 3, 4, 5]. In patients with sudden‐onset severe abdominal pain that is disproportionate to physical findings, clinicians should consider visceral artery dissection and proceed promptly to contrast‐enhanced imaging [5].

Author Contributions

So Sakamoto: investigation, writing – original draft, writing – review and editing, visualization.

Ethics Statement

Ethical approval was not required at our institution for this case report.

Consent

Written informed consent for publication was obtained from the patient.

Conflicts of Interest

The author declares no conflicts of interest.

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.