Table 2.

Differential diagnosis table for acute mesenteric ischemia

Differential of Mesenteric Ischemia	History	CT Findings
Reversible causes of mesenteric ischemia (cocaine, shock bowel, other drugs)	History of Cocaine or other drug use, variable onset (acute in the case of cocaine), history of hypovolemia or heart failure	Variable bowel wall thickness and contrast enhancement (can have decreased enhancement, increased enhancement, or target like appearance), variable appearance of the mesenteric vessels and mesenteric fat, imaging findings are dependent on phase of ischemia
Arterial Occlusion (from atherosclerosis, aneurism, dissection, or embolism)	History of atherosclerosis, cardiac arrhythmia, valvular disease, acute onset	Variable thickness of bowel wall, filling defect within mesenteric vessels, variable bowel wall attenuation, no significant change in caliber of small bowel (unless late phase), no significant mesenteric changes (in early phase), variable enhancement
Venous occlusion (from portal/mesenteric venous thrombus or venous stasis)	Portal hypertension, right sided heart failure, hypercoagulable state	Wall thickening, decreased attenuation of bowel wall (unless hemorrhage is present), mesenteric fluid and ascites, variable enhancement
Mechanical strangulation (from closed loop obstruction, mass, or fibrosis)	Acute onset, intestinal malrotation, prior abdominal surgery	“whirl” sign, “spoke wheel” sign, hazy mesentery, thickened bowel wall with decreased enhancement (unless there is hemorrhage), variable enhancement, bowel dilatation with air fluid levels, venous engorgement
Miscellaneous direct mesenteric insults	History of vasculitis, trauma, cytotoxic drugs (chemotherapy agents, prior radioembolization)	Wall thickening, variable enhancement pattern, bowel dilatation, bowel necrosis (advanced stage)