Learning objectives
To review the characteristics of gastrointestinal (GI) vascular lesions,
their classification and findings on contrast-enhanced CT (CECT) angiography.
Background
Vascular lesions of the GI tract conform a heterogeneous group of abnormalities which are a potential cause of hemorrhage.
GI bleeding may range from mild or obscure bleeding to severe and life-threatening,
especially in cases with an arterial origin.
Multidetector CT angiography has a high diagnostic yield detecting vascular lesions.
Besides,
an adequate diagnosis is crucial to lead the optimal therapeutic approach (direct endoscopic,
angiographic embolization or surgery).
Findings and procedure details
GI vascular lesions can be classified based on common morphology and enhancement patterns:
Angioectasias (Angiodysplasias): one of the most common causes of occult gastrointestinal bleeding.
Angioectasias consist of a proliferation of tortuous venules and capillaries within the submucosa.
They can appear anywhere in the GI tract,
but are most common in the colon,
particularly in the cecum and ascending colon.
The incidence of angiodysplasia increases with age,
but they can also be associated with other conditions such as aortic stenosis,
renal failure or hereditary hemorrhagic...
Conclusion
Vascular lesions may cause GI bleeding,
which can present as mild obscure bleeding with chronic anemia,
but can be life-threatening,
especially in cases with an arterial origin.
Multiphase CECT has a high diagnostic value in the detection and characterization of these lesions,
and also provides information about the presence or absence of active bleeding and its source.
The findings on multiphase CECT help to guide the optimal treatment (endoscopic intervention,
angiographic embolization,
or surgery),
and the timing to implement these interventions.
References
Huprich,
J.
E.,
Barlow,
J.
M.,
Hansel,
S.
L.,
Alexander,
J.
A.,
& Fidler,
J.
L.
(2013).
Multiphase CT enterography evaluation of small-bowel vascular lesions.American Journal of Roentgenology,201(1),
65-72.
Al-Hamid H (2016).
Angiodysplasia of the Colon.
Medscape
Artigas,
J.
M.,
Martí,
M.,
Soto,
J.
A.,
Esteban,
H.,
Pinilla,
I.,
& Guillén,
E.
(2013).
Multidetector CT angiography for acute gastrointestinal bleeding: technique and findings.Radiographics,33(5),
1453-1470.
Raman,
S.
P.,
Horton,
K.
M.,
& Fishman,
E.
K.
(2013).
MDCT and CT angiography evaluation of rectal bleeding: the role...