Superior mesenteric artery syndrome with associated Nutcracker syndrome
Diagnosis almost certain
Presentation
Recurrent episodes of abdominal pain with vomiting.
Patient Data
Age: 30 years
Gender: Female
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There is an acute angulation of the superior mesenteric artery (SMA) compressing the third part of the duodenum with reduced aortomesenteric angle and aortomesenteric distance in keeping with the superior mesenteric artery syndrome.
Also, there is compression of the left renal vein between the SMA and aorta in keeping with the Nutcracker syndrome.
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Annotated images:
- aortomesenteric angle = 20° (normal: 28-65°)
- aortomesenteric distance = 8 mm (normal: 10-34 mm)
- the compression ratio of the anteroposterior diameter of the pre-compressed left renal vein (6.10 mm) divided by that of the compressed vein (2.23 mm): 6.10/2.23 = 2.73 (a compression ratio above 2.25 is highly sensitive and specific for nutcracker syndrome )
Case Discussion
CT features of a superior mesenteric artery syndrome with associated Nutcracker syndrome.
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