CT Diagnosis of Median Arcuate Ligament Compression Syndrome with Spontaneous Isolated Superior Mesenteric Artery Dissection: A Case Report
-
摘要: 本文探讨1例正中弓状韧带压迫综合征合并肠系膜上动脉夹层的CT表现及转归，多层螺旋CT血管成像三维重建能清晰地观察到腹腔干狭窄程度、侧支循环建立、肠系膜上动脉夹层转归和重塑的动态过程，有助于判断病情，指导临床治疗。Abstract: This article explores the CT findings and outcome of a case involving median arcuate ligament compression syndrome complicated with spontaneous isolated superior mesenteric artery dissection. Three-dimensional reconstruction of multi-detector spiral CT angiography can effectively display the degree of abdominal trunk stenosis, development of collateral circulation, and dynamic process of superior mesenteric artery dissection remodeling. This approach is valuable for evaluating the disease and guiding the clinical treatment.
-
Key words:
- tomography /
- X-ray computer /
- median arcuate ligament /
- superior mesenteric artery /
- aortic dissection
-
图 1 入院当日MDCTA显示正中弓状韧带压迫综合征并肠系膜上动脉夹层
Figure 1. MDCTA on the admission day shows median arcuate ligament compression syndrome with superior mesenteric artery dissection
图 2 入院第五日矢状位MPR重建示夹层内膜片模糊，假腔范围增大，形态不规则
Figure 2. Sagittal MPR reconstruction on the fifth day post admission shows blurred diaphragms and enlarged pseudolumen, with irregular morphology
图 3 二个月后矢状位MPR重建示假腔呈囊袋状，腔内血栓明显吸收
Figure 3. Sagittal MPR reconstruction two months post admission shows a bag-like pseudolumen with obvious thrombus absorption
图 4 8.5个月后薄层MIP（a）和VR（b）重建示假腔缩小，血栓完全吸收，假腔右侧壁侧支血管较前增粗（弯箭头）
Figure 4. After 8.5 months of admission, thin-layer MIP (a) and VR (b) reconstruction show reduced pseudolumen, complete thrombus absorption, and dilatated collateral vessels in the right lateral wall of the pseudolumen (curved arrow)
-
[1] HORTON K M, TALAMINI M A, FISHMAN E K. Median arcuate ligament syndrome: Evaluation with CT angiography[J]. Radiographics, 2005, 25(5): 1177−1182. doi: 10.1148/rg.255055001 [2] GÜMÜ H, GÜMÜ M, TEKBA G, et al. Clinical and multidetector computed tomography findings of patients with median arcuate ligament syndrome[J]. Clinical Imaging, 2012, 36(5): 522−525. doi: 10.1016/j.clinimag.2011.11.031 [3] 陈奇元, 杨萍, 张鹏天, 等. 正中弓状韧带压迫腹腔干综合征伴侧支循环形成1例[J]. 医学影像学杂志, 2022,32(8): 1448−1449.CHEN Q Y, YANG P, ZHANG P T, et al. MSCTA findings of celiac trunk syndrome with collateral circulation formed by compression of median arcuate ligament: One case report[J]. Journal of Medical Imaging, 2022, 32(8): 1448−1449. (in Chinese). [4] 秦甜甜, 王盼, 于晓辉. 正中弓状韧带压迫综合征1例并文献复习[J]. 疑难病杂志, 2022,21(3): 307−308. doi: 10.3969/j.issn.1671-6450.2022.03.020QIN T T, WANG P, YU X H. Median arcuate ligament syndrome. one case report and literature review[J]. Chinese Journal of Difficult and Complicated Case, 2022, 21(3): 307−308. (in Chinese). doi: 10.3969/j.issn.1671-6450.2022.03.020 [5] 中国医师协会介入医师分会外周血管介入专业委员会. 孤立性肠系膜上动脉夹层诊治专家共识[J]. 中华放射学杂志, 2021,55(4): 352−358. doi: 10.3760/cma.j.cn112149-20200506-00649Chinese College of Interventionalists Committee on Peripheral Vascular Intervention. Expert consensus on the management of isolated superior mesenteric artery dissection[J]. Chinese Journal of Radiology, 2021, 55(4): 352−358. (in Chinese). doi: 10.3760/cma.j.cn112149-20200506-00649 [6] SOLIS M M, RANVAL T J, MCFARLAND D R, et al. Surgical treatment of superior mesenteric artery dissecting aneurysm and simultaneous celiac artery compression[J]. Annals of Vascular Surgery, 1993, 7(5): 457−462. doi: 10.1007/BF02002130 [7] 杨进军, 张桂平, 班允清. 孤立性肠系膜上动脉夹层的超声影像学特征及预后分析[J]. 中国超声医学杂志, 2022,38(11): 1268−1271. doi: 10.3969/j.issn.1002-0101.2022.11.018ZHANG J J, ZHANG G P, BAN Y Q. Analysis of ultrasonographic features and prognosis of isolated superior mesenteric artery dissection[J]. Chinese Journal of Ultrasound in Medicine, 2022, 38(11): 1268−1271. (in Chinese). doi: 10.3969/j.issn.1002-0101.2022.11.018 [8] WU Z, YI J, XU H, et al. The significance of the angle between superior mesenteric artery and aorta in spontaneous isolated superior mesenteric artery dissection[J]. Annals of Vascular Surgery, 2017, 11(45): 117−126. [9] SATOKAWA H, TAKASE S, SETO Y, et al. Management strategy of isolated spontaneous dissection of the superior mesenteric artery[J]. Annals of Vascular Diseases, 2014, 7(3): 232−238. doi: 10.3400/avd.oa.14-00071 [10] TOMITA K, OBARA H, SEKIMOTO Y, et al. Evolution of computed tomographic characteristics of spontaneous isolated superior mesenteric artery dissection during conservative management[J]. Circulation Journal, 2016, 80(6): 1452−1459. doi: 10.1253/circj.CJ-15-1369 [11] 孙敏, 罗彩华, 苏秦, 等. CT平扫在自发性孤立性肠系膜上动脉夹层诊断中的意义[J]. 医学影像学杂志, 2018,28(1): 113−116.SUN M, LUO C H, SU Q, et al. The significance of non-contrast-enhanced computed tomography scan in the diagnosis of spontaneous isolated superior mesenteric artery dissection[J]. Journal of Medical Imaging, 2018, 28(1): 113−116. (in Chinese). [12] 曹阿丹, 宋敏, 武乐乐, 等. 正中弓状韧带压迫综合征双源CT血管造影表现[J]. 临床放射学杂志, 2021,40(6): 1235−1238.CAO A D, SONG M, WU L L, et al. Imaging features of dual-source CT angiography of median arcuate ligament compression syndrome[J]. Journal of Clinical Radiology, 2021, 40(6): 1235−1238. (in Chinese). [13] 黎艳, 李玉民, 刘向华, 等. MSCT在自发性孤立性肠系膜上动脉夹层诊断中的应用[J]. 国际医学放射学杂志, 2021,44(4): 471−475.LI Y, LI Y M, LIU X H, et al. Application of multislice spiral CT in the diagnosis of spontaneous isolated superior mesenteric artery dissection[J]. International Journal of Medical Radiology, 2021, 44(4): 471−475. (in Chinese). [14] 倪国庆, 苏浩波, 陈国平, 等. 孤立性肠系膜上动脉夹层分型及治疗策略[J]. 介入放射学杂志, 2019,28(7): 701−705.NI G Q, SU H B, CHEN G P, et al. The classification and management strategy of isolated superior mesenteric artery dissection[J]. Journal of Interventional Radiology, 2019, 28(7): 701−705. (in Chinese). [15] YUN W S, KIM Y W, PARK K B, et al. Clinical and angiographic follow-up of spontaneous isolated superior mesenteric artery dissection[J]. European Journal of Vascular and Endovascular Surgery, 2009, 37(5): 572−577. doi: 10.1016/j.ejvs.2008.12.010 [16] 周喜田, 周卫忠, 刘海日, 等. 胰十二指肠切除术后急性正中弓状韧带压迫综合征介入治疗一例[J]. 中华放射学杂志, 2021,55(9): 989−991.ZHOU X T, ZHOU W Z, LIU H R, et al. Interventional treatment of acute median arcuate ligament syndrome after pancreaticoduodenectomy: A case report[J]. Chinese Journal of Radiology, 2021, 55(9): 989−991. (in Chinese). [17] 靳明旭, 尤佳, 张娣, 等. 自发孤立性肠系膜上动脉夹层: MSCTA特征及保守治疗后影像学转归[J]. 中国医学计算机成像杂志, 2021,27(2): 136−141.JIN M X, YOU J, ZHANG D, et al. Spontaneous isolated superior mesenteric artery dissection: MSCTA characteristics and radiological outcomes after conservative treatment[J]. Chinese Computed Medical Imaging, 2021, 27(2): 136−141. (in Chinese). [18] 连利珊, 张喆, 张志文, 等. 自发性孤立性肠系膜上动脉夹层治疗策略的影响因素分析[J]. 国际外科学杂志, 2022,49(6): 427−432.LIAN L S, ZHANG Z, ZHANG Z W, et al. Analysis of influencing factors of therapeutic strategies for spontaneous isolated superior mesenteric artery dissection[J]. International Journal of Surgery, 2022, 49(6): 427−432. (in Chinese). -
下载:
点击查看大图
图(5)
计量
- 文章访问数: 140
- HTML全文浏览量: 111
- PDF下载量: 13
- 被引次数: 0
