Abdominal vessels: Subtle things to look for before labelling 'normal study'

Congress:

ECR 2020

Poster Number:

C-01012

Type:

Educational Exhibit

Keywords:

Performed at one institution, Observational, Not applicable, Obstruction / Occlusion, Haemodynamics / Flow dynamics, Education and training, Localisation, Contrast agent-intravenous, Computer Applications-Detection, diagnosis, Ultrasound-Spectral Doppler, Ultrasound-Colour Doppler, CT-Angiography, Vascular, Gastrointestinal tract, Abdomen

Authors:

N. P. NEUPANE¹, K. Koirala²; ¹Bhaktapur/NP, ²Kathmandu/NP

DOI:

10.26044/ecr2020/C-01012

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-01012

Fig. 1: Axial CT angiography image showing compression of the coeliac artery at its...

Fig. 2: 3D reconstructed VRT image in a patient with median arcuate ligament syndrome...

Fig. 3: B mode ultrasound image showing narrowed distance between the superior...

Fig. 4: CT angiography axial image showing reduced aorto-mesenteric distance at the ...

Learning objectives

To learn about the abnormal origin and course of abdominal vessels. To identify subtle change in vessel's course and caliber and correlate them with the presenting symptoms of the patients.

Background

Abdominal vascular causes can lead to refractory abdominal symptoms in many of the cases. Many a times these patients are evaluted inadequately and are labelled normal based on the imaging studies that the clinicians ask for. Careful vascular evaluation of the patients, however, can not only help us in making the diagnosis but can also provide us with a roadmap for further management of the patients.

Findings and procedure details

Patients presenting with recurrent abdominal pain were meticulously evaluated using ultrasonogram, Doppler and CT studies based on the need of the study identified. Many of the patients were found to have vascular causes like compression of the celiac artery by the median arcuate ligament (median arcuate ligament syndrome), compression of duodenum by the superior mesenteric artery (SMA syndrome), compression of left renal vein in between superior mesenteric artery and aorta (nutcracker syndrome) in addition to the atherosclerotic manifestations and post inflammatory vascular manifestations. We present...

Conclusion

Abdominal imaging studies including abdominal ultrasonogram, Doppler and CT abdomen are regularly carried out for patients with recurrent abdominal pain. Many a times, we tend to look at the visceral organs, intestines, abdominal and pelvic walls and label these studies as normal. However, subtle changes in abdominal vessel's course, calibre and orientation can be a cause for recurrent pain, which if not meticulously looked for, can be easily missed. A careful observation of the abdominal vessels in every study can lead us to the correct...

Personal information and conflict of interest

N. P. Neupane; Bhaktapur/NP - nothing to disclose K. Koirala; Kathmandu/NP - nothing to disclose

References

Ilica AT, Kocaoglu M, Bilici A, Ors F, Bukte Y, Senol A, Ucoz T, Somuncu I. Median arcuate ligament syndrome: multidetector computed tomography findings. Journal of computer assisted tomography. 2007 Sep 1;31(5):728-31. Agrawal GA, Johnson PT, Fishman EK. Multidetector row CT of superior mesenteric artery syndrome. Journal of clinical gastroenterology. 2007 Jan 1;41(1):62-5. Kurklinsky AK, Rooke TW. Nutcracker phenomenon and nutcracker syndrome. InMayo Clinic Proceedings 2010 Jun 1 (Vol. 85, No. 6, pp. 552-559). Elsevier. Agrawal GA, Johnson PT, Fishman EK. Splenic artery aneurysms and...