COMPRESSION SYNDROMES AS INCIDENTAL FINDINGS DURING MULTISLICE COMPUTED TOMOGRAPHY OF ABDOMINAL ORGANS AND RETROPERITONEAL SPACE

Objective.To estimate the clinical significance of compression syndromes accidentally detected by multislice computed tomography (MSCT) of the abdominal cavity and retroperitoneal space.

Material and methods. Intravenous bolus contrast-enhanced MSCT study was performed in 645 patients with different diseases of the abdominal cavity and retroperitoneal space. The information obtained after analysis of diagnostic images was compared with clinical symptoms and, in some cases, with intraoperative data.

Results. MSCT study identified prerequisites for the occurrence of compression syndromes in 71 (11%) patients of the study group, of whom 11 (15%) patients were noted to have relevant clinical manifestations. Surgical treatment was performed in 3 cases; medical treatment proved to be effective in the remaining 8 cases.

Conclusion. Compression syndromes were diagnosed in 11 (1.7%) of the 645 patients examined by MSCT for different diseases of the abdominal cavity and retroperitoneal space. Their timely and adequate diagnosis could rule out other diseases with similar clinical manifestations and define optimal tactics. 

1. Lamba R., Tanner D.T., Sekhon S., McGahan J.P., Corwin M.T., Lall C.J. Multidetector CT in vascular compression syndromes in the abdomen and pelvis. RadioGraphics. 2014; 34: 93–115.

2. Sturide A., Alemauno G., Guidici F., Addaci R., Bellucci F., Tonelli F. Medial arcuate ligament syndrome in a patient with Crohn’s disease. Intern. J. Surg. Case Rep. 2013; 4: 399–402.

3. Sempere Ortega C., Gallego Rivera I., Shahin M. Gastric ischemia as an unusual presentation of median arcuate ligament compression syndrome. Br. Inst. Radiol. 2017; 3 (1): 20160005. DOI: 10.1259/bjrcr.20160005

4. Curl J.H., Thompson N.W., StanleyJ.C. Median arcuate ligament compression of the celiac and superior mesenteric arteries. Ann. Surg. 1971; 173 (2): 314–20.

5. Ромашин С.О., Куликов В.П., Гервазиев В.Б., Лубянский В.Г. Диагностика экстравазальной компрессии чревного ствола методом дуплексного сканирования. Ангиология и сосудистая хирургия. 1999; 5 (2): 25–32. [Romashin S.O., Kulikov V.P., Gervaziev V.B., Lubyanskiy V.G. Diagnosis of extravasal compression of the celiac trunk by duplex scanning. Angiology and Vascular Surgery.1999; 5 (2): 25–32 (in Russ.).]

6. Lee V.S., Morgan J.N., Tan A.G., Pandharipande P.V., Krinsky G.A., Barker J.A. et al. Celiac artery compression by the median arcuate ligament: a pitfall of end-expiratory MR imaging. Radiology. 2003; 228: 437–42.

7. Suzuki K., Tachi Y., Ito S., Maruyama K., Mori Y., Komada T. et al. Endovascular managment of rupted pancreatoduodenal artery aneurysms associated with celiac axis stenosis. Cardiovasc. Interv. Radiol. 2008; 31 (6): 1082–7.

8. Cornell S.H. Severe stenosis of celiac axis: analysis of patients with and without symptoms. Radiology. 1971; 99: 311–6.

9. Fond J.K.K., Poh A.C.C., Tan A.G.C., Taneja R. Imaging findings and clinical features of abdominal vascular compression syndromes. Am. J. Radiol. 2014; 203: 29–36.

10. Ahmed K., Sampath R., Khan M.S. Current trends in the diagnosis and management of renal nutcracker syndrome: a review. Eur. J. Vasc. Endovasc. Surg. 2006; 31: 410–6.

11. Хартинг О. Синдром сдавления левой почечной вены в аортомезентериальном пинцете. Флеболимфология. 2010; 36: 10–5. [Harting O. Syndrome of compression of the left renal vein in aortomesenteric forceps. Phlebolymphology. 2010; 36: 10–5 (in Russ.).]

12. He Y., Wu Z., Chen S. et al. Nutcracker syndrome – how well do we know it? Urology. 2014; 83: 12–7.

13. Barka M., Mallat F., Hmida W., Chavey S.O., Ahmed K.B., Abdallah A.B., Tlili K. Posterior nutcracker syndrome with left renal vein duplication as a cause of gross hematuria and recurrent left varicocele in an eight-year-old boy. Intern. J. Case Rep. Imag. 2014; 5(8): 572–5.

14. Orczyk K., Labetlowicz P., Lodzinski S., Stefanczyk L., Topol M., Polguj M. The nutcracker syndrome. Morphology and clinical aspects of the important vascular variations: a systematic study of 112 cases. Intern. Angiol. 2016; 35 (1): 71–4.

15. Oh M.J. Superior mesenteric artery syndrome combined with renal nutcracker syndrome in a young male: a case report. Korean J. Gastroenterol. 2017; 70 (5): 253–60. DOI: 10.4166/kjg.2017.70.5.253

16. Ananthan K., Onida S., Davies A.H. Nutcracker syndrome: an update on current diagnostic criteria and management guidelines. Eur. J. Vasc. Endovasc. Surg. 2017; 53: 886–94.

17. Stephens F.D. Ureterovascular hydronephrosis and the “aberrant” renal vessels. J. Urol. 1982; 128 (5): 984–7.

18. Gupta M., Smith A.D. Crossing vessels: endourologic implications. Urol. Clin. North. Am. 1998; 25 (2): 289–93.

19. Park J.M., Bloom D.A. The pathophysiology of UPJ obstruction: current concepts. Urol. Clin. North. Am. 1998; 25 (2): 161–9.

20. Rouviere O., Lyonett D., Berger P., Pangaud C., Gelet A., Martin X. Ureteropelvic junction obstruction: use of helical CT for preoperative assessment – comparison with intraarterial angiography. Radiology. 1999; 213 (3): 668–73.

21. Frauscher F., Janetschek G., Helweg G., Strasser H., Bartsch G., zur Nedden D. Crossing vessels at the ureteropelvic junction: detection with contrastenhanced color Doppler imaging. Radiology. 1999; 210(3): 727–31.

22. Zeltser I.S., Liu J.B., Bagley D.H. The incidence of crossing vessels in patients with normal ureteropelvic junction examined with endoluminal ultrasound. J. Urol. 2004; 172(6,pt 1): 2304–7.

23. Caliskan S., Sungur M. Hydronephrosis due to ureteropelvic junction obstruction in an adult: crossing vessels. J. Integr. Nephrol. Angiol. 2015; 2 (4): 139–40. DOI: 10.4103/2225-1243.168548

24. Guren A. Crossing renal vessel causing ureteropelvic odstruction in children. J. Integr. Nephrol. Angiol. 2016; 3 (2): 31–2. DOI: 10.4103/ 2394-2916.181215

25. Mishall P.L., Tubbs R.S., Shoja M.M., Loukas M. Renal arteries. In: Bergman’s comprehensive encyclopedia of human anatomic variation. New York: John Wiley and Sons, Inc.; 2016: 682–93.