Type:
Educational Exhibit
Keywords:
Varices, Pelvic floor dysfunction, Education and training, Screening, Education, Cost-effectiveness, Ultrasound-Power Doppler, Ultrasound-Colour Doppler, Ultrasound, Vascular, Pelvis, Genital / Reproductive system female
Authors:
M. B. Campagno1, S. A. Rivadeneira2, D. M. V. Arch3; 1Buenos Aires/AR, 2C.A.B.A., CA/AR, 3C.A.B.A./AR
DOI:
10.26044/ecr2019/C-1731
Findings and procedure details
PELVIC CONGESTION SYNDROME
The criteria for establishing the ultrasonographic diagnosis of SCP include1-3:
- Urethral and ovarian plexuses and / or tortuous pelvic veins with a diameter> 6 mm.
- Slow flow (<3 cm / s) or reversal of flow in ovarian veins.
- Dilated myometrial arcuate veins that communicate with varicose pelvic veins.
- Reflux and dilatation of the venous trunks on Valsalva,
reflux must be >1 s within the venous trunks and persist until the end of the manoeuvre.
Any associated varices should show flow reversal and distension on Valsalva
NUTCRACKER SYNDROME
The nutcracker phenomenon refers to the compression of the left renal vein between the aorta and the superior mesenteric artery.
In 1937,
the position of the left renal vein between the aorta and superior mesenteric artery was described as being similar to that of a nut between the jaws of a nutcracker.4
The nutcracker syndrome is a clinical entity,
caused by such compression that leads to abdominal pain,
hematuria and pelvic congestion.
Duplex ultrasound provides hemodynamic data,
which can aid in the diagnosis.3
The high velocity coefficients measured in the renal veins at the aortic-mesenteric junction and the hilum are indicative of the syndrome.5
Diagnostic Tips:
- Decrease in mesenteric aortic diameter less than 3mm,
with a normal diameter of 10-14mm.
- Mesenteric aortic angle less than 16 °.
- INCREASE IN SPEED: 15-20cm / sec in the hilum and 40-50cm / sec in the aortic-mesenteric portion
MAY THURNER SYNDROME
May-Thurner syndrome,
also known as iliac vein compression syndrome and Cockett syndrome,
consists of obstruction of the left LV caused by the crossing of the right common iliac artery.5
Clinical results arise from chronic venous stasis in the left lower limb associated with inflammation with or without thrombosis of the left iliac vein and femoral veins.6
Clinically,
it is characterized by chronic edema,
pain,
hyperpigmentation,
varicose veins,
acute thrombosis of the left iliac vein,
and skin ulceration.7
Diagnostic Tips:
- Increase in venous velocity: pre / intra stenosis ratio> 2.5
- Loss of respiratory phase flow
- Turbulent flow with mosaic pattern in compression site
- Inadequate response to the valsalva.
- Investment of the ipsilateral flow
- Signs of Thrombosis
- Increase in distal vein diameter
- Distance between the primitive iliac artery and the column <5mm
Phlebography with pressure measurement is the gold standard for the diagnosis of May-Thurner Syndrome.7