Endocrine Abstracts

Introduction: Incidental Coeliac artery dissection (CoAD) is an uncommon presentation of abdominal pain akin to post-prandial pain of mesenteric ischemia. Risk factors include hypertension, smoking, dyslipidaemias, pregnancy, atherosclerosis, trauma, or fibromuscular dysplasia. Imaging features of CoAD include an intimal flap, aneurysmal changes, mural thrombus, and (or) fat stranding. We report 2 novel cases of CoAD in patients with small bowel NETs with mesenteric masses.

Case 1: A 55-year-old male, presented with acute abdominal pain and distension. CT revealed a 50mm mesenteric mass. Biopsy confirmed Grade 1 metastatic well-differentiated NET. Urinary 5HIAA was 167 umol/24 hour and Chromogranin A was 265 ng/mL. This was intensely avid on Octreoscan SPECT-CT. Treatment with Lanreotide Autogel 120 mg deep SC every 28 days was commenced. Post-biopsy CT revealed a focal dissection flap, involving the coeliac trunk, a 12 mm coeliac artery diameter at the level of dissection with normal SMA and IMA. The Vascular multidisciplinary team reviewed the scan with a plan for serial follow-up scans. This was regarded an incidental CoAD with aneurysmal change.

Case 2: A 63-year-old male originally presented with severe carcinoid syndrome and carcinoid heart disease (he underwent PV and TV replacements) from a Grade 1 metastatic terminal ileum NET, with extensive liver metastasis. He underwent liver embolization which went uneventfully. Immediate post-procedure CT scan showed an 80% targeted liver lesion response. However, a follow-up scan four weeks later revealed a new dissection flap with aneurysmal changes at the origin of the coeliac artery, measuring 12 mm in diameter. The vascular multidisciplinary team has recommended conservative management with continued CT monitoring.

Conclusion: Coeliac artery dissection may be underreported due to the foregut collateral networks making the presentation variable and bowel ischemia infrequent. Treatment is most often conservative with endovascular or surgical management reserved for complicated cases. Complications include aneurysm formation, rupture, and arterial occlusion. We believe this is the first report of coeliac artery dissection associated with mesenteric mass in NETs, whilst this could be incidental it may relate to the fibrotic nature of the mesenteric mass and possibly implicated in causation.