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Table 1 Imaging findings of the various vascular compression syndromes of the abdomen and pelvis

From: The role of multidetector CT angiography in characterizing vascular compression syndromes of the abdomen

SyndromeVessels/structures involvedMDCT imaging pearls
Median arcuate ligament syndromeMedian arcuate ligament compresses the celiac arteryο Focal narrowing of the proximal celiac artery with a characteristic hooked appearance
ο Post-stenotic dilatation
Superior mesenteric artery syndromeSuperior mesenteric artery compresses D3 segment of duodenum against the aortaο Reduced aorto-mesenteric distance and aorto-mesenteric angle
ο Dilated D1 and D2 segments and the stomach
Portal biliopathyPortal vein collaterals compress the common bile ductο Cavernous transformation of the portal vein
ο Marked dilatation of the intra and extrahepatic biliary radicles
Nutcracker syndromeSuperior mesenteric artery compresses the left renal vein against the aortaο 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 vesselsAberrant renal vessel compresses the pelviureteric junctionο Aberrant course of renal vessel
ο Moderate to marked hydronephrosis
Retrocaval ureterInferior vena cava compresses the right ureterο Proximal right ureter lies posterior to the IVC
ο Moderate to marked right hydroureteronephrosis
May-Thurner syndromeRight common iliac artery compresses the left common iliac veinο Compressed left CIV (> 50% compression)
ο Thrombosed left iliac and proximal femoral veins