Abdominal vascular compression syndromes encountered in the emergency department: cross-sectional imaging spectrum and c
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REVIEW ARTICLE
Abdominal vascular compression syndromes encountered in the emergency department: cross-sectional imaging spectrum and clinical implications Mohd Zahid 1 & Pankaj Nepal 2 & Arpit Nagar 3 & Vijayanadh Ojili 1 Received: 13 February 2020 / Accepted: 2 April 2020 # American Society of Emergency Radiology 2020
Abstract This is a review article on cross-sectional imaging spectrum of abdominal and pelvic vascular compression syndromes in emergency settings, discussing about pathophysiology, clinical presentation, imaging findings, and appropriate management of such entities. It is important to understand the overlap of imaging findings with common anatomic variations. Equally, the subtle imaging features of abdominal vascular compression syndrome may be equivocal for interpreting radiologist. Early recognition is important, in order to refer patients for appropriate treatment. Cross-sectional imaging with computed tomography (CT) and magnetic resonance imaging (MRI) is usually performed to detect such abdominal vascular compression syndromes. For comprehensive review, the utility of color Doppler in evaluation and diagnosis is also emphasized in each section. Percutaneous angiography is usually considered as a reference standard for the diagnosis but limited due to its invasive nature. Surgical and endovascular management of these vascular compression syndromes is briefly described. Keywords Abdominal . Vascular compression . Syndromes . Cross-section imaging
Introduction Abnormal vascular compression by the adjacent viscera or vice versa, compression of abdominal hollow viscus by nearby vascular structure, may be seen on cross-sectional imaging. When such compressions become symptomatic, they result in a variety of syndromes such as median arcuate ligament syndrome (MALS), superior mesenteric artery (SMA) syndrome, anterior and posterior nutcracker syndromes, May-Thurner syndrome, ovarian vein syndrome, pelviureteric junction and ureteral obstruction due to retrocaval ureter, and vascular impressions. In this article, we will discuss pathophysiology, clinical symptoms, typical imaging findings, and appropriate management of such conditions (Table 1). Of note, * Vijayanadh Ojili [email protected] 1
Department of Radiology, University of Texas Health, San Antonio, TX, USA
2
Department of Radiology, St. Vincent’s Medical Center, Bridgeport, CT, USA
3
Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH, USA
asymptomatic individuals with such anatomical abnormalities are usually managed conservatively. Therefore, imaging findings must be interpreted in conjunction with the clinical symptoms to appropriately label them with the diagnosis of vascular compression syndrome (Table 2).
Median arcuate ligament syndrome Median arcuate ligament syndrome (MALS), also known as Dunbar syndrome, results from abnormal compression of celiac artery by the median arcuate ligament. MALS was first described by Harjola in 1963 and later in 1965 by Dunbar, in patients with symptomatic abdomi
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