A man with the rare simultaneous combination of three abdominal vascular compression syndromes: median arcuate ligament syndrome, superior mesenteric artery syndrome, and nutcracker syndrome

Radiology Case Reports

Pietro Valerio Foti¹  Renato Farina²  Cecilia Gozzo²  Tiziana Vasile²  Andrea Conti²  Isabella Pennisi²  Massimo Venturini²  Antonio Basile³ 

[1] Corresponding author.;Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, Radiodiagnostic and Radiotherapy Unit, Catania, Italy;Diagnostic and Interventional Radiology Department, Circolo Hospital, Insumbria University, Varese, Italy;

关键词: Median arcuate ligament syndrome;    Nutcracker syndrome;    Superior mesenteric artery syndrome;    Doppler ultrasound;    Cardiovascular Abnormalities;    Weight loss;   

DOI  :  

来源: DOAJ

【 摘 要 】

Median arcuate ligament syndrome and superior mesenteric artery syndrome are well-known abdominal compression syndromes, the coexistence of which is rarely described in literature. In addition, due to the common pathogenesis, anterior nutcracker syndrome may occur simultaneously to superior mesenteric artery syndrome.To our knowledge, this is the first case reporting combination of these 3 syndromes detected with ultrasound, Computed Tomography and upper gastrointestinal fluoroscopic exam.A 69-year-old man came to our attention for rapid weight loss, postprandial epigastric pain and recurrent vomiting for at least 6 months. Doppler ultrasound showed both celiac artery and left renal vein stenosis with simultaneous left varicocele. Computed tomography showed a reduction of aortomesenteric space causing both left renal vein and duodenal stenosis, this latter confirmed by upper gastrointestinal fluoroscopic exam. The diagnosis of these three vascular compression syndromes (MALS, SMAS, and anterior NCS) has been formulated, based on clinical and imaging findings.We assumed that the postprandial crises caused by median arcuate ligament syndrome may induce a reduction of meals consumption and progressive weight loss which can be a cause of anterior nutcracker syndrome and superior mesenteric artery syndrome onset.Doppler ultrasound, in expert hands, allows to accurately diagnosing these syndromes which are often underestimated. Failure to recognize it and inadequate treatment could have serious consequences for patients' health.

【 授权许可】

Unknown