Purpose or Case Report: Vascular compression syndromes of the abdomen, including median arcuate ligament syndrome, superior mesenteric artery syndrome, and nutcracker syndrome, are challenging clinical entities with imaging findings that may be confusing. Imaging plays a decisive role in the diagnostic algorithm in children because clinical findings alone can be nonspecific and functional abdominal pain is common. Findings of angiography, CT, MRI, and fluoroscopy for these syndromes have been widely described and provide useful information to aid in the diagnosis of these syndromes. Sonographic findings have also been described in the literature, but are less known and possibly perplexing, with variable diagnostic criteria in children. Ultrasound is therefore likely underutilized in evaluating these abnormalities despite its ability to provide anatomic, physiologic, and most importantly, dynamic information in a cost-effective manner without the use of ionizing radiation. The purpose of this exhibit is to review the clinical features of vascular compression syndromes in the abdomen, review ultrasound imaging findings and discuss diagnostic criteria.
Methods & Materials: A single institution retrospective review was conducted to identify pediatric patients with vascular compression syndromes in the abdomen. Each patient’s imaging studies were correlated with clinical course, imaging findings of other modalities, and surgical findings when possible.
Results: Relevant anatomy, sonographic appearance, as well pertinent clinical features associated with vascular compression syndromes of the abdomen are presented. Cases of median arcuate ligament syndrome, superior mesenteric artery syndrome, and nutcracker syndrome are presented to illustrate sonographic imaging technique. Cased-based examples are supplemented with a review of the current literature.
Conclusions: Several vascular compression syndromes can occur in the abdomen, and may be challenging diagnoses in the pediatric population. Knowledge of the sonographic manifestations of these conditions can improve patient care by providing additional information that may be key in these difficult cases.