Abstract

Abdominopelvic vascular compression syndromes include a variety of uncommon conditions characterized by either extrinsic compression of blood vessels by adjacent anatomical structures (i.e., median arcuate ligament syndrome, nutcracker syndrome, May-Thurner syndrome) or compression of hollow viscera by adjacent vessels (i.e., superior mesenteric artery syndrome, ureteropelvic junction obstruction, ureteral vascular compression syndromes, portal biliopathy). These syndromes can be unexpectedly diagnosed even in asymptomatic patients and the predisposing anatomic conditions can be incidentally discovered on imaging examinations performed for other indications, or they can manifest with atypical abdominal symptoms and acute complications, which may lead to significant morbidity if unrecognized. Although computed tomography (CT) is an accurate noninvasive technique for their detection, the diagnosis remains challenging due to the uncommon clinical presentation and often overlooked imaging features. Dynamic imaging may be performed in order to evaluate patients with inconstant symptoms manifesting in a specific position. The purposes of this paper are to review the CT imaging findings of abdominopelvic vascular compression syndromes, correlating with anatomical variants and to provide key features for the noninvasive imaging diagnosis.

Highlights

  • Abdominopelvic vascular compression syndromes include a large spectrum of abdominal conditions (Table 1) characterized by either extrinsic compression of blood vessels by adjacent anatomical structures or compression of hollow viscera by adjacent vessels [1]

  • Abdominopelvic vascular compression syndromes may cause a wide spectrum of atypical abdominal symptoms or acute complications

  • Anatomical findings predisposing to these compression syndromes may be discovered even in asymptomatic subjects who undergo imaging for unrelated indications

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Summary

Introduction

Abdominopelvic vascular compression syndromes include a large spectrum of abdominal conditions (Table 1) characterized by either extrinsic compression of blood vessels by adjacent anatomical structures (i.e., median arcuate ligament syndrome, nutcracker syndrome, MayThurner syndrome) or compression of hollow viscera by adjacent vessels (i.e., superior mesenteric artery syndrome, ureteropelvic junction obstruction, ureteral vascular compression syndromes, portal biliopathy) [1]. The exact prevalence of these syndromes is not known, but it can be estimated based on the prevalence of

Compression of the celiac artery by the median arcuate ligament
Superior mesenteric artery syndrome
Ureteral vascular compression syndromes
Portal biliopathy
Findings
Conclusions
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