Segmental arterial mediolysis: a challenging diagnosis in internal medicine

Segmental arterial mediolysis (SAM) is an uncommon, nonatherosclerotic, noninflammatory, large- to medium-sized arteriopathy first described in 1976, affecting splanchnic branches of the aorta. The clinical presentation ranges from asymptomatic to severe, life-threatening intra-abdominal hemorrhage and shock. A healthy 53-year-old woman with abdominal pain was referred to our facility for further management of superior mesenteric artery dissection diagnosed in the emergency room. A computed tomography scan revealed a dissection in both renal arteries, leading to ischemic degeneration in the left apical pole of the kidney. Additionally, three aneurysmatic dilatations, ectasia of intrahepatic vessels, and irregularities in the wall of the iliac arteries were identified. No other pathological lesions were observed. Based on imaging and the absence of inflammatory and autoimmune markers, a diagnosis of SAM was made. Since an endovascular intervention was excluded and both anticoagulation and antiplatelet therapy were initiated, the patient has undergone close clinical and radiological follow-up.