Abdominal thrombotic and ischemic manifestations of the antiphospholipid antibody syndrome: CT findings in 42 patients

PURPOSE: To determine the abdominal computed tomographic (CT) findings in p atients with antiphospholipid antibody syndrome (APS). MATERIALS AND METHODS: Retrospective review of medical records from two uni versity medical centers from 1994 through 1997 revealed 215 patients who ha d a hypercoagulable state attributed to primary or secondary APS. Abdominal CT findings in these patients were reviewed for evidence of large-vessel o cclusion or visceral ischemia. RESULTS: In 42 (19.5%) of 215 patients with APS (age range, 32-65 years; me an age, 42 years), abdominal thromboses or ischemic events were detected at CT. Twenty-two (52%) had major vascular thromboses, including those in the inferior vena cava (n = 10), portal and superior mesenteric veins (n = 7), splenic vein (n = 4), and aorta (n = 1). Thirty-six (86%) patients had abd ominal visceral ischemia resulting in renal infarction (n = 22), bowel isch emia (n = 13), splenic infarction (n = 6), pancreatitis (n = 3), hepatic in farction (n = 1), and/or hepatic dysfunction with portal hypertension (n = 1). In some patients, more than one abdominal organ and/or vessel was invol ved. CONCLUSION: Patients who have circulating antiphospholipid antibodies are a t risk for major abdominal vascular thromboses and organ infarction. Radiol ogists must be familiar with this syndrome; they may be the first physician s to suggest the diagnosis on the basis of findings of unusual or recurrent sites of thrombosis, especially in young patients.