PMC10173838_01
Magnetic resonance imaging. (a) This coronal reconstruction shows varicocele (arrows). (b) In this axial reconstruction we can observe left renal vein congestion (long arrow). superior mesenteric artery (short arrow). (c) This axial reconstruction shows duodenum compression in aortomesenteric space (long arrow). Prestenotic duodenum tract (short arrow)
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MRI revealed gonadal plexus congestion [Figure 2a], left renal vein dilatation [Figure 2b], and duodenal compression in aortomesenteric space [Figure 2c].
Nutcracker syndrome. Gray-scale ultrasound. (a) In this longitudinal ultrasound scan of abdominal aorta the aortomesenteric distance has been measured. (b) The aortomesenteric distance (arrow) can also be measured with a transversal ultrasound scan of abdominal aorta. (c) This longitudinal scan shows aortomesenteric angle (a) measurement which is obtained by tracing two lines along longitudinal axis of aorta and superior mesenteric artery
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Gray-scale ultrasound showed significant aortomesenteric distance reduction (3.2 mm) [Figure 3a and b], aortomesenteric angle (AOM) reduction (18 ) [Figure 3c], and left renal vein compression with pre and post-stenotic dilatation.
Duplex Doppler ultrasound of abdominal aorta. (a) Left renal vein peak speed velocity (PSV) measurement performed in prestenotic tract shows a severe flow slowing (5.6 cm/s). (b) PSV measurement of celiac artery, performed in expiratory apnea, shows much higher values than in inspiratory apnea phase in stenotic tract (c)
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Duplex Doppler ultrasound of left renal vein showed: Prestenotic flow congestion with low peak speed velocity (PSV) (5.6 cm/s) [Figure 4a] and poststenotic PSV increase (15.6 cm/s) with flow ratio (FR) of 2.78 (PSV of poststenotic tract/PSV of prestenotic tract); regular resistive index in renal arteries (<0.69); severe stenosis at celiac artery origin with a notable PSV increase in forced expiration (267.8 cm/s) [Figure 4b], less in forced inspiration (238 cm/s) [Figure 4c]; the celiac artery FR, measured in expiratory apnea, was 5.9.
Computed tomography examination performed after oral administration of contrast agent (Gastrografin). (a) This reconstruction according to a coronal plan shows duodenum (d) stomach (St) dilatation due to the narrowing of aortomesenteric space (arrow), as can be better highlighted in axial scan (b), where it is possible to notice the severe distance reduction between superior mesenteric artery and aorta (arrow) in aortomesenteric space. Duodenum (d), Stomach (St)
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CT examination after oral contrast medium administration which showed gastric, first and second duodenum dilatation and duodenum stenosis in aortomesenteric space [Figure 5a and b].
The Doppler ultrasound control performed 2 months after surgery showed a significant reduction in peak speed velocity in the celiac artery in both expiratory apnea (a) and in both inspiratory apnea (b)
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After 2 months, the patient had an increase of 6 kg, AOM increase (19 ), and PSV reduction in celiac artery (172. 4 cm/s, measured in forced expiration) [Figure 6a and b].