Learning objectives
To analyze and describe the normal morphological and hemodynamic characteristics of the superior mesenteric artery (SMA) in abdominal ultrasound exploration using B-mode and color,
power and spectral Doppler mode.
To review possible anomalies of the SMA either anatomical variants,
stenotic / occlusive,
or by its own disposition to compromise adjacent structures.
To interpret the usual and pathological flow parameters and speeds of the SMA.
To describe an evaluation analysis to correctly explore the SMA by optimizing the exploration time.
Background
Although it fulfills an essential function such as the irrigation of the small intestine and part of the large intestine,
the SMA is a forgotten vessel in the abdominal ultrasonographic study,
both on duty,
routine or in the abdominal Doppler evaluation.
However,
this vessel may be affected by various pathologies,
both stenotic/occlusive (atherosclerosis or fibromuscular dysplasia and non-atherosclerotic cause) or by its own disposition,
cause extrinsic compressive pathology such as Nutcracker syndrome or Wilkie syndrome,
may also present anatomical variations.
Hence the importance of its...
Findings and procedure details
The evaluation of the SMA should be performed with the patient fasting and in the supine position using a low frequency convex transducer of 2.5-3.5MHz.
The exploration is started in the sub xiphoid transverse section identifying the abdominal aorta artery,
using in many cases the left hepatic lobe and the pancreas as an acoustic window for a correct visualization.
Once the aorta is identified,
the anterior wall of the aorta should be explored in search of the celiac trunk easily distinguishable by its typical presentation...
Conclusion
Diagnostic imaging specialists play a fundamental role in the diagnosis of rare but not less important pathologies related to the superior mesenteric artery,
the aorto mesenteric compass and the alterations that arise from it,
as in the case of Nutcracker syndrome.
"Nutcracker" and the Wilkie Syndrome.
B-mode abdominal ultrasound,
color,
power and spectral Doppler should be the initial method of study since it is a non-invasive,
innocuous,
accessible and inexpensive method.
Radiologists should be able to identify the usual and pathological findings to make an...
Personal information
Resident Doctors of the Radiology department,
ultrasound service.
Hospital Rossi,
La Plata,
Buenos Aires,
Argentina.
Rolleri Fajardo,
Jeremías Benjamín
email:
[email protected]
Lima Condo,
Claudia Mónica
email:
[email protected]
Mattocio Vevenis,
Juan Pablo
email:
[email protected]
References
1.Moneta GL,
Yeager RA,
Dalman R,
at al.
Duplex ultrasound criteria for diagnosis of splanchnic artery stenosis or occlusion.
J Vasc Surg,
1991; 14:511-520
2.Welsch T,
et al.
Recordando el síndrome de la arteria mesentérica superior.Dig Surg.2007;24:149-156.
3.Kurklinsky AK,
Rooke TW.
Nutcracker phenomenon and nutcracker syndrome.Mayo Clin Proc.
2010;85(6):552-9.
4.Okamura S,
et al.Tratamiento de la oclusión aguda de la arteria mesentérica superior mediante terapia trombolítica.Case Rep Gastroenterol.2009;3(3):300-305.
5.Lorentziadis ML.El síndrome de Wilkie.Una causa rara de obstrucción duodenal.Annals of gastroenterology-2011,24(1),59-61.
6.Patel NC.
et al.Un caso de...