Reversible 'Unstable' Abdominal Angina Caused by Ruptured Plaque of the Superior Mesenteric Artery: Clinical and Radiological Correlations

• Published in: European journal of case reports in internal medicine Vol. 10; no. 4; p. 003766
• Main Authors: Yaari, Shaul, Hiller, Nurith, Samet, Yacov, Heyman, Samuel N
• Format: Journal Article
• Language: English
• Published: Italy SMC Media Srl 2023
• Subjects: atherosclerosis; superior mesenteric artery; unstable angina; atheromatous plaque; Mesenteric ischemia; abdominal angina
• ISSN: 2284-2594; 2284-2594
• DOI: 10.12890/2023_003766

Unstable angina, characteristic of coronary artery disease, is caused by in-situ clot formation complicating ruptured atheromatous plaque. Abdominal angina, however, usually reflects chronic mesenteric ischaemia, caused by multi-vessel stable plaques involving mesenteric arteries. Herein, we describe a patient with new-onset abdominal pain caused by a ruptured atheromatous plaque at the superior mesenteric root. The diagnosis was based on an evident reversible epigastric bruit and high-degree eccentric stenosis caused by a non-calcified atheroma. Symptoms and bruit resolved within 3 weeks on aspirin and statins with regression of the stenotic lesion. Although the condition is likely common, this is the first clear-cut report compatible with 'unstable' abdominal angina, resolved by conservative treatment. Resembling unstable angina pectoris, ruptured atheromatous plaque in mesenteric vessels can develop, clinically manifested by new-onset abdominal angina.This condition may be reversible under treatment with antiplatelet medications and statins.Searching for abdominal bruit is invaluable in the assessment of unexplained abdominal pain.