Figure 6c. Acute mesenteric ischemia in a 57-year-old man with long-standing atherosclerotic heart disease who presented with acute abdominal pain and watery diarrhea. (a) Axial contrast-enhanced volume-rendered multi-detector row CT scan demonstrates pneumatosis of several small bowel loops in the right side of the abdomen (arrows). (b) Lateral volume-rendered 3D multi-detector row CT scan demonstrates calcified plaque at the origins of the celiac axis (straight arrow) and SMA (curved arrow) as well as moderate calcified plaque in the aorta. (c) On axial oblique 3D multi-detector row CT scans (right image obtained inferior to left image), the SMA (curved arrow) has a smaller caliber than the celiac axis (straight arrow). Surgery revealed infarction of the distal small bowel with associated ischemic changes in the right colon. Severe stenosis was noted at the origin of the SMA with minimal stenosis at the celiac origin. Endarterectomy of the SMA was performed along with a bypass graft procedure.