Chronic Phlebosclerotic Ischemic Colitis

Phlebosclerosis of the mesenteric vein is a rare cause of ischemic colitis. The clinicopathologic findings of chronic phlebosclerotic ischemic colitis are different from conventional ischemic colitis. We report a case showing the following features: (1) plain abdominal radiography-vascular calcifications at the ascending colon and transverse colon, (2) abdominal computed tomography (CT) colonic wall thickening with intramural calcification and mesenteric venous calcification, (3) barium enemaluminal narrowing, wall rigidity and thumbprinting appearance, (4) superior mesenteric angiographydecreased vascularity of right colon, narrowing or occlusion of the marginal arteries, disturbance of venous return, dilatation and tortuosity of the veins along the vasa recta, (5) colonscopy-dark purple-colored edematous mucosa and prominent submucosal veins, (6) colonscopic biopsy-marked fibrous thickening with hyalinization of mucosal venous wall, narrowing of the lumen but no thrombus. The pathognomonic hallmark for radiological diagnosis of chronic phlebosclerotic ischemic colitis is the vascular calcifications in the colonic wall and mesenteric veins seen on plain abdominal radiography and abdominal CT.