The role of ultrasound imaging in vascular compression syndromes

Abstract

Vascular compression syndromes are rare alterations that have in common the compression of an arterial and/or venous vessel by contiguous structures and can be congenital or acquired. The best known are the Thoracic Outlet Syndrome, Nutcracker Syndrome, May–Thurner Syndrome, and Dunbar Syndrome. The incidence of these pathologies is certainly underestimated due to the non-specific clinical signs and their frequent asymptomaticity. Being a first-level method, Ultrasound plays a very important role in identifying these alterations, almost always allowing a complete diagnostic classification. If in expert hands, this method can significantly contribute to the reduction of false negatives, especially in the asymptomatic population, where the finding of the aforementioned pathologies often happens randomly following routine checks. In this review, we briefly discuss the best known vascular changes, the corresponding ultrasound anatomy, and typical ultrasound patterns.

An interesting presentation of a rare association of the Wilkie and Nutcracker syndromes

“…In fact, the WS, although is rare, can be a cause of abdominal occlusion in young women. Doppler ultrasound (US) is considered the first-level examination for the evaluation of vascular compression syndromes [2 , 9 , 10] . However, patients with WS usually come to the emergency with an upper abdominal occlusion and the diagnosis is mostly made on CT [1 , 3 , 11] .…”

“…Although hypertension is not generally included in the traditional clinical manifestations of NCS, it has been reported in rare cases as the first manifestation of NCS [14 , 15] . The first line imaging tool to follow or diagnose the NCS is usually the Doppler US which allows us to obtain an estimate of LRV stenosis degree [3 , 9 , 12] . On CT the entrapment of the renal vein between the aortomesenteric space is visualized as the “beak sign” [2] .…”

Atypical case of coexistent vascular compression syndromes: median arcuate ligament syndrome and nutcracker syndrome

“…In spite of their shared aetiology, concomitant NCS and SMAS is seldom reported 20. In NCS, narrowing of the AMA leads to the classical LRV compression (nut) between the aorta and the SMA (cracker),21 commonly during rapid increase in height during puberty, explaining the predilection for younger patients 18. MALS occurs due to a low insertion of the diaphragm and high origin of the coeliac axis and has been noted with NCS in just one other case in the literature 1 10.…”

Commentary: Subclavian Artery Flow Dynamics Evaluated by Analytical Intraoperative Indocyanine Green Videoangiography During Surgical Treatment of Thoracic Outlet Syndrome: Case Series

“…So, I do not quite support the authors' notion that "ICG videoangiography can be a good candidate for evaluating TOS surgery." But it will be worthwhile to further implement and work on new diagnostic methods (for nTOS and arterial TOS 8 ), and the authors certainly contributed to this.…”

“…But it will be worthwhile to further implement and work on new diagnostic methods (for nTOS and arterial TOS 8 ), and the authors certainly contributed to this.…”