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Bernardo C. Mendes, MD, Gustavo S. Oderich, MD, Thanila A

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1 Ischemic liver lesions mimicking neoplasm in a patient with severe chronic mesenteric ischemia 
Bernardo C. Mendes, MD, Gustavo S. Oderich, MD, Thanila A. Macedo, MD, Roger K. Moreira, MD  Journal of Vascular Surgery Cases  Volume 1, Issue 2, Pages (June 2015) DOI: /j.jvsc Copyright © 2015 The Authors Terms and Conditions

2 Fig 1 A, Computed tomography angiography (CTA) of the abdominal aorta demonstrates a highly calcified aorta and bilateral iliac vessels, with occlusion of the celiac axis and a long segment of the superior mesenteric artery (SMA). B, Schematic drawing and (C) intraoperative photograph show a 14-mm × 7-mm bifurcated polyester graft originating from the supraceliac aorta, with one limb anastomosed end-to-side to the common hepatic artery and one limb tunnelled retropancreatic and anastomosed end-to-side to the distal SMA. Reprinted by permission of the Mayo Foundation for Medical Education and Research. All rights reserved. Journal of Vascular Surgery Cases 2015 1, DOI: ( /j.jvsc ) Copyright © 2015 The Authors Terms and Conditions

3 Fig 2 A, Portal venous-phase computed tomography angiography (CTA) demonstrates two hypodense, hepatic lesions measuring 4 cm and presenting with enhancing and cystic components in the segment VIII, with associated segmental bile duct dilation, and a nonhomogeneous mass measuring 6 cm in the segment VI. B, Postoperative CTA demonstrates nearly complete resolution of hepatic lesions after hepatic and mesenteric revascularization. C, Top, Colon biopsy specimen shows colonic mucosa with focal areas of crypt “withering” and associated hyalinization of the lamina propria, consistent with ischemic-type injury. A focus of acute inflammation (crypt abscess) is also present (hematoxylin and eosin, original magnification ×400. Bottom, Needle core biopsy sample shows extensive coagulative necrosis of the liver parenchyma with surrounding fibrous tissue and minimal reactive inflammatory infiltrate, without evidence of malignancy (hematoxylin and eosin, original magnification ×200). Reprinted by permission of the Mayo Foundation for Medical Education and Research. All rights reserved. Journal of Vascular Surgery Cases 2015 1, DOI: ( /j.jvsc ) Copyright © 2015 The Authors Terms and Conditions

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