Acute onset abdominal pain constitutes a significant proportion of emergency department visits, but only a small fraction of these cases are attributable to vascular pathologies (Bauersfeld, 1947 [1Bauersfeld S.R. Dissecting aneurysm of the aorta: a presentation of 15 cases and a review of the recent literature Ann Intern Med 1947 ;  26 : 873-889

Cliccare qui per andare alla sezione Riferimenti]). In this case, report, we present an incidental diagnosis of Spontaneous Isolated Superior Mesenteric Artery Dissection (SISMAD). A 69-year-old man was admitted to the emergency department complaining of fever, loss of appetite, vague epigastric pain, dysuria, and a productive cough for several days. A lower extremity venous Doppler ultrasound was performed, and a deep venous thrombosis (DVT) was identified in the left main femoral vein and in the proximal segment of the superficial vein. The patient also had no blood flow in the distal part of left external iliac vein. A contrast-enhanced computerized tomography angiography of the thorax and abdomen was performed to detect pulmonary embolism and the etiology of the abdominal pain. No pulmonary embolism was found; however, multiple metastatic nodules were identified in both lungs, as well as infiltration on the posterobasal field of the right lung, metastases on the liver, focal dilatation, and an intimal flap on the middle-distal part of the superior mesenteric artery (SMA) at 2 cm, with a segment that was compatible with isolated dissection. There was a contrast passage on the distal part of SMA, and no sign of bowel ischemia.