A 67-year-old man presents to the clinic with a 6-month history of progressively worsening abdominal pain that occurs shortly after meals. He reports significant weight loss during this period. His past medical history includes hypertension, hyperlipidemia, and coronary artery disease. He takes lisinopril, atorvastatin, metoprolol, and aspirin. He has a 30-pack-year smoking history and continues to smoke. Vital signs are within normal limits. On physical examination, his abdomen is soft, nondistended, and nontender, with normal bowel sounds.
Which of the following is the best next step in the diagnosis of this patient’s condition?
C) Computed tomography (CT) angiography
The patient's presentation of postprandial abdominal pain, and weight loss in the setting of hypertension, hyperlipidemia, vascular disease, and tobacco use is most consistent with chronic mesenteric ischemia (CMI). CT angiography is the best next step for diagnosis as it can visualize the mesenteric vessels and detect stenosis or occlusion.
Answer choice A: Abdominal ultrasound, is incorrect. Abdominal ultrasound is useful for evaluating biliary and hepatic pathology but is not the best test for visualizing mesenteric vasculature.
Answer choice B: Colonoscopy, is incorrect. Colonoscopy is useful for evaluating lower gastrointestinal pathology but does not assess mesenteric blood flow.
Answer choice D: Esophagogastroduodenoscopy (EGD), is incorrect. EGD can identify upper gastrointestinal lesions such as peptic ulcers but does not evaluate mesenteric arteries.
Answer choice E: Serum amylase and lipase levels, is incorrect. Serum amylase and lipase levels are useful for diagnosing pancreatitis but are not relevant for mesenteric ischemia.
Key Learning Point
In a patient with postprandial abdominal pain, significant weight loss, and a history of vascular disease, chronic mesenteric ischemia should be suspected. CT angiography is the most appropriate imaging study to visualize mesenteric vessels and detect stenosis or occlusion.
