Table 1 Imaging findings of the various vascular compression syndromes of the abdomen and pelvis
Syndrome | Vessels/structures involved | MDCT imaging pearls |
|---|---|---|
Median arcuate ligament syndrome | Median arcuate ligament compresses the celiac artery | ο Focal narrowing of the proximal celiac artery with a characteristic hooked appearance ο Post-stenotic dilatation |
Superior mesenteric artery syndrome | Superior mesenteric artery compresses D3 segment of duodenum against the aorta | ο Reduced aorto-mesenteric distance and aorto-mesenteric angle ο Dilated D1 and D2 segments and the stomach |
Portal biliopathy | Portal vein collaterals compress the common bile duct | ο Cavernous transformation of the portal vein ο Marked dilatation of the intra and extrahepatic biliary radicles |
Nutcracker syndrome | Superior mesenteric artery compresses the left renal vein against the aorta | ο Beak sign—compressed part of the left renal vein appears like a beak ο Distended gonadal veins |
Pelvi-ureteric junction obstruction due to crossing of vessels | Aberrant renal vessel compresses the pelviureteric junction | ο Aberrant course of renal vessel ο Moderate to marked hydronephrosis |
Retrocaval ureter | Inferior vena cava compresses the right ureter | ο Proximal right ureter lies posterior to the IVC ο Moderate to marked right hydroureteronephrosis |
May-Thurner syndrome | Right common iliac artery compresses the left common iliac vein | ο Compressed left CIV (> 50% compression) ο Thrombosed left iliac and proximal femoral veins |