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Figure 1f. Natural history of AA. The patient was a 64-year-old woman who had lost 12 kg and was experiencing characteristic cramping abdominal pain after meals. (a, b) Panoramic three-dimensional (3D) volume-rendered (VR) (a) and maximum-intensity-projection (MIP) (b) images show high-grade stenoses at the origins of the celiac trunk and SMA. Collateral intestinal perfusion is supplied by the IMA via a hypertrophic Riolan arc (arrow). (c-f) Magnified views show the high-grade stenoses more clearly. Several days after undergoing multi-detector row CT angiography, the patient developed rapidly progressing abdominal pain and a rising serum lactate level. (g) Abdominal CT scans show signs of bowel ischemia, with distended small bowel loops and wall thickening. Results of surgery performed the following day confirmed necrosis of the entire small bowel. The patient died the day after surgery.
