An uncommon association of abdominal vascular compression syndromes: Dumbar and Nutcracker

Linares, Pedro; Vivas, Santiago; Domínguez, A.; Jorquera, Francisco; Muñoz, Fernando; Espinel, Jesús; Herrera, A; Olcoz, J.L.

doi:10.1097/00042737-200210000-00017

Cited by 8 publications

(6 citation statements)

References 6 publications

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“…Combined NCS and Dumbar syndrome (also known as median arcuate ligament syndrome) has been reported. 87 Hartung et al 72 had a patient with previously stented May-Thurner syndrome, and we have described a case of combined May-Thurner and NCS. 88 …”

Section: Clinical Featuresmentioning

confidence: 68%

Nutcracker Phenomenon and Nutcracker Syndrome

Kurklinsky¹,

Rooke

2010

Mayo Clinic Proceedings

423

586

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N utcracker phenomenon (NCP), also known as left renal vein entrapment,1-3 is characterized by impeded outflow from the left renal vein (LRV) into the inferior vena cava (IVC) due to extrinsic LRV compression, often accompanied by demonstrable lateral (hilar) dilatation and medial (mesoaortic) narrowing (schematic representation of NCP/ nutcracker syndrome [NCS] in Figure 1). Although the terms nutcracker syndrome and nutcracker phenomenon are sometimes used interchangeably in the literature, Shin and Lee 4 emphasize that the nutcracker anatomy is not always associated with clinical symptoms and that some of the anatomic findings suggestive of nutcracker may represent a normal variant or be accounted for by other conditions. Therefore, the term nutcracker syndrome should be reserved for patients with characteristic clinical symptoms associated with demonstrable nutcracker morphologic features. No consensus exists on what symptoms are severe enough to warrant the designation of a clinical syndrome or to what extent various findings may simply reflect different evolutionary stages of the process. Because of these uncertainties, some authors focus on the characteristic anatomic and hemodynamic findings, referring to them as NCP rather than NCS. 5Nutcracker phenomenon refers to compression of the left renal vein, most commonly between the aorta and the superior mesenteric artery, with impaired blood outflow often accompanied by distention of the distal portion of the vein. The nutcracker syndrome (NCS) is the clinical equivalent of nutcracker phenomenon characterized by a complex of symptoms with substantial variations. Depending on specific manifestations, NCS may be encountered by different medical specialists. Although it may be associated with substantial morbidity, the diagnosis of NCS is often difficult and is commonly delayed. Diagnostic and treatment criteria are not well established, and the natural history of NCS is not well understood. We performed an initial review of the literature through MEDLINE, searching from 1950 to date and using the keywords nutcracker syndrome, nutcracker phenomenon, and renal vein entrapment. We performed additional reviews based on the literature citations of the identified articles. We attempted to elucidate clinical relevance of these conditions and their prominent features and to summarize professional experience. Mayo Clin

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Section: Clinical Featuresmentioning

confidence: 68%

Nutcracker Phenomenon and Nutcracker Syndrome

Kurklinsky¹,

Rooke

2010

Mayo Clinic Proceedings

423

586

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“…Most of patients are young [1][2][3][4]8], thin individuals with acute post prandial (beginning from 15 to 30 minutes after meals), exercise related [1] or chronic epigastric pain, hyperemesis, vomiting, diarrhoea and weight loss [1][2][3][4][5][6].…”

Section: Discussionmentioning

confidence: 99%

“…Clinical manifestations are vague and diagnosis may rely on findings at duplex and color flow Doppler sonography [2,8], angiographic [2,3,19,20,21,25], CT [3,4,9,21] or MR [2,6,22] imaging but differentiation between clinically relevant celiac artery compression and incidental narrowing may be difficult [16,22].…”

Section: Discussionmentioning

confidence: 99%

“…Celiac artery compression also known as median arcuate ligament or Dunbar's syndrome is an uncommon disorder characterized, in symptomatic patients, by transient postprandial or exercise-related or chronic epigastric pain, hyperemesis, vomiting, diarrhoea and weight loss [1][2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

“…The incidence of median arcuate ligament is not clearly established, the majority of literature consisting of isolated reports [1][2][3][4]8].…”

Section: Introductionmentioning

confidence: 99%

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Celiac Artery Compression by the Median Ligament: An Uncommon Cause of Abdominal Pain in the Emergency Department. Report of a Case~!2009-12-31~!2010-05-06~!2010-07-06~! DONE

Ferri¹,

Magrini²,

Capotondi³

et al. 2010

TOEMJ

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Abstract:The Authors report a case of a patient presenting in the Emergency Department (ED) with severe epigastric pain refractory to therapeutic treatment, with onset after forced ice water ingestion caused by joking compression of a soft PET ® bottle during drinking.The Angio MR and angiography performed, after exclusion of suspected esophagus rupture and other esophago-gastric diseases, to rule out an ischemic origin of the pain demonstrate a stenosis of the celiac artery resulting from median arcuate ligament narrowing, the so-called Dunbar's Syndrome.The Dunbar's Syndrome is uncommon and some aspects such as the vascular etiology of symptoms are still controversial.In this report clinical presentation, differential diagnosis and pathophysiology of this disease are discussed.

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Clinical anatomy of celiac artery compression syndrome: A review

et al. 2007

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Anatomic variations are often responsible for a variety of clinical conditions. In this review we investigate compression of the celiac artery and the superior mesenteric artery by the median arcuate ligament (MAL), diaphragmatic crura, or the celiac nerve plexus. This clinical condition known as celiac artery compression syndrome (CACS) has proven controversial in definition and relevance. This condition was first described as chronic abdominal pain because of the mesenteric ischemia caused by extrinsic compression of the celiac artery. Dunbar and others presented surgical approaches to decompress the celiac artery by releasing the MAL. Definitive answers have been sought to classify and relieve the clinical symptoms patients experience postprandially. Persistent symptoms following surgical treatment for CACS have led investigators to question the existence of this disease. Advances in technology such as angiographic MRI and color duplex ultrasonography have refreshed the importance of considering compression of the celiac artery during differential diagnoses. Because of the varying anatomic etiologies of disease, it is not possible to pinpoint a single cause for CACS. Potential etiologies for compression of the celiac artery include a "high take off" origin of the celiac artery compressed by normal diaphragmatic crura and MAL, a normal origin of the celiac artery with long diaphragmatic crura and MAL, large bilaterally fused celiac ganglia (with or without the involvement of the superior mesenteric ganglia) compressing the celiac trunk, celiacomesenteric trunk compression by diaphragmatic crura and MAL, or combinations of the above mentioned entities. In this review we describe potential sources of compression of the celiac artery by regional structures and treatments of CACS in an effort to justify the relevance of CACS in modern medicine.

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An uncommon association of abdominal vascular compression syndromes: Dumbar and Nutcracker

Cited by 8 publications

References 6 publications

Nutcracker Phenomenon and Nutcracker Syndrome

Nutcracker Phenomenon and Nutcracker Syndrome

Celiac Artery Compression by the Median Ligament: An Uncommon Cause of Abdominal Pain in the Emergency Department. Report of a Case~!2009-12-31~!2010-05-06~!2010-07-06~! DONE

Clinical anatomy of celiac artery compression syndrome: A review

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