Vascular changes of the superior mesenteric artery (SMA): A new component of the hypovolemic shock complex (HSC)

•CT perfusion anomalies of abdominal organs are often observable in shock.•These changes are summarized under the term CT hypovolemic shock complex (HSC).•Concomitant vascular changes in the abdomen have not yet been investigated.•Alterations of the superior mesenteric artery occurred very often in HSC.•Thus, changes in SMA may be an additional and reproducible vascular sign of HSC. To assess the type and frequency of vascular changes in the superior mesenteric artery (SMA) associated with the hypovolemic shock complex (HSC). Twenty-six patients (14 males, 70.6 ± 11.2 years) meeting the criteria for hypovolemic shock complex in computed tomography were examined for the presence of angiographic signs of non-occlusive mesenteric ischemia (NOMI) in the SMA: the string of sausages sign and spasms of the arcades of mesenteric arteries on coronal maximum intensity projection images (MIP). Interrater agreement was assessed using weighted kappa (κ). Vascular changes of the SMA were visible in almost all of the patients with HSC with a frequency of 88.5 %–96.2 %. Intraclass correlation coefficients indicated a substantial to almost perfect interrater agreement. Using computed tomography, it is possible to reliably and reproducibly detect vascular changes in SMA known from angiography in the context of hypoperfusion. The pathological vascular changes also occur more frequently than other classic signs of a CT hypoperfusion complex. Since the qualitative assessment of the SMA requires only a small amount of time, it is suitable as a further criterion for the presence of the CT hypoperfusion complex.