Superior mesenteric artery compression disorders - Radiological imaging and clinical considerations

Congress:

ECR 2019

Poster Number:

C-1574

Type:

Educational Exhibit

Keywords:

Obstruction / Occlusion, Diagnostic procedure, CT-Angiography, CT, Vascular, Abdomen

Authors:

S. Ilic¹, Z. Badnjar², S. Odalovic³, D. Raceta Masic²; ¹Podgorica, Montenegro/ME, ²Podgorica/ME, ³Belgrade/RS

DOI:

10.26044/ecr2019/C-1574

DOI-Link:

https://dx.doi.org/10.26044/ecr2019/C-1574

Fig. 1: Normal aorto-mesenteric angle and its content in 61 years old man , MDCT...

Fig. 2: Nutcracker Syndrome in a 60 years old man with gross hematuria and weight loss...

Fig. 3: Nutcracker syndrome in a 12 years old girl with history of macroscopic...

Fig. 4: Nutcracker Syndrome in a 32 years old woman with microscopic hematuria and...

Learning objectives

·To understand anatomical bases of the disease. ·To define specific anatomic findings in SMA syndrome and Nutcracker syndrome. · To appriciete clinical consideration in diagnosis.

Background

There are two distinct vascular compression disorders due to compression of another structure by the superior mesenteric artery. Wilkie syndrome or Superior mesenteric artery syndrome is defined as compression of the third part of the duodenum by the SMA. Nutcracker or renal vein entrapment syndrome implies compression of the the left renal vein by the SMA. Superior mesenteric artery (SMA) syndrome is an uncommon but well recognized clinical entity characterized by compression of the third, or transverse, portion of the duodenum between the aorta and...

Findings and procedure details

MDCT abdominal angiography is considered gold standard for diagnosis of SMA and Nutcracker syndrome. CT criteria for the diagnosis of superior mesenteric artery syndrome include an aortomesenteric angle of less than 22 degrees and an aortomesenteric distance of less than 8-10 mm. Also, it can be used to assess intra-abdominal and retroperitoneal fat , duodenal distension and signs of compression of the left renal vein . We are presenting 6 patients : one with normal aorto-mesenteric angle and its content ; one of them with...

Conclusion

Although there are established CT criteria including aortomesenteric distance and aortomedenteric angle , these numeric values can not be considered in an absolute manner because there is overlapping between patients with SMAS and asymptomatic individuals Therefore clinical considerations are always needed , and the diagnosis of those two syndromes is frequently one of exclusion.

Personal information

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References

1. Gerasimidis T, George F. Superior Mesenteric Artery Syndrome. Wilkie Syndrome.Dig Surg. 2009 May 20. 26(3):213-214.[Medline]. 2. Cope C, Isard HJ.Left renal vein entrapment: a new diagnostic finding in retroperitoneal disease.Radiology1969;92(4):867-872 [PubMed] 3. Barnes RW, Fleisher HL, III, Redman JF, Smith JW, Harshfield DL, Ferris EJ.Mesoaortic compression of the left renal vein (the so-called nutcracker syndrome): repair by a new stenting procedure.J Vasc Surg.1988;8(4):415-421 [PubMed] 4. Rudloff U, Holmes RJ, Prem JT, Faust GR, Moldwin R, Siegel D.Mesoaortic compression of the left renal vein (nutcracker...