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Incidental Anatomic Finding of Celiacomesenteric Trunk Associated with ‘Nutcracker Phenomenon,’ or Compression of the Left Renal Vein

Patient: Female, 91 Final Diagnosis: Nutcracker syndrome • celiacomesenteric trunk Symptoms: Dyspepsia • dysphagia Medication: — Clinical Procedure: — Specialty: Surgery OBJECTIVE: Congenital defects/diseases BACKGROUND: Celiacomesenteric trunk (CMT) is a very rare anatomic finding in which the celi...

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Autores principales: Peterson, Joshua, Hage, Anthony N., Diljak, Stephan, Long, Benjamin D., Marcusa, Daniel P., Brzezinski, David W., Eliason, Jonathan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: International Scientific Literature, Inc. 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5742474/
https://www.ncbi.nlm.nih.gov/pubmed/29242494
http://dx.doi.org/10.12659/AJCR.906283
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author Peterson, Joshua
Hage, Anthony N.
Diljak, Stephan
Long, Benjamin D.
Marcusa, Daniel P.
Brzezinski, David W.
Eliason, Jonathan
author_facet Peterson, Joshua
Hage, Anthony N.
Diljak, Stephan
Long, Benjamin D.
Marcusa, Daniel P.
Brzezinski, David W.
Eliason, Jonathan
author_sort Peterson, Joshua
collection PubMed
description Patient: Female, 91 Final Diagnosis: Nutcracker syndrome • celiacomesenteric trunk Symptoms: Dyspepsia • dysphagia Medication: — Clinical Procedure: — Specialty: Surgery OBJECTIVE: Congenital defects/diseases BACKGROUND: Celiacomesenteric trunk (CMT) is a very rare anatomic finding in which the celiac artery and the superior mesenteric artery (SMA) originate from the abdominal aorta through a common trunk. Clinical associations with CMT include arterial aneurysm, thrombosis, and celiac artery compression. However, an association between CMT and abdominal venous congestion caused by left renal vein compression, or ‘nutcracker phenomenon,’ has not been previously reported. CASE REPORT: A 91-year-old woman, who died from a cerebrovascular accident (CVA), underwent a cadaveric examination at our medical school. On examination of the abdomen, there was an incidental finding of CMT. The arterial and venous diameters were measured, and vascular histopathology was undertaken. The vascular anatomy was consistent with CMT type 1-b. Nutcracker phenomenon (NCP) (left renal vein compression) was seen anatomically as dilatation and engorgement of the left renal vein, relative to the right renal vein (10.77±0.13 mm vs. 4.49±0.56 mm, respectively), and dilatation and engorgement of the left ovarian vein, relative to the right ovarian vein (4.37±0.15 mm vs. 1.06±0.09 mm, respectively) with left ovarian varicocele. The aortoceliac angle (ACA) and the aortomesenteric angle (AMA) approached zero degrees. CONCLUSIONS: We have described a rare anatomic finding of CMT that created an acute AMA and NCP. Awareness of this rare association between CMT and NCP by clinicians, vascular surgeons, and radiologists may be of value in the future evaluation and surgical management of patients who present clinically with ‘nutcracker syndrome.’
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spelling pubmed-57424742018-01-02 Incidental Anatomic Finding of Celiacomesenteric Trunk Associated with ‘Nutcracker Phenomenon,’ or Compression of the Left Renal Vein Peterson, Joshua Hage, Anthony N. Diljak, Stephan Long, Benjamin D. Marcusa, Daniel P. Brzezinski, David W. Eliason, Jonathan Am J Case Rep Articles Patient: Female, 91 Final Diagnosis: Nutcracker syndrome • celiacomesenteric trunk Symptoms: Dyspepsia • dysphagia Medication: — Clinical Procedure: — Specialty: Surgery OBJECTIVE: Congenital defects/diseases BACKGROUND: Celiacomesenteric trunk (CMT) is a very rare anatomic finding in which the celiac artery and the superior mesenteric artery (SMA) originate from the abdominal aorta through a common trunk. Clinical associations with CMT include arterial aneurysm, thrombosis, and celiac artery compression. However, an association between CMT and abdominal venous congestion caused by left renal vein compression, or ‘nutcracker phenomenon,’ has not been previously reported. CASE REPORT: A 91-year-old woman, who died from a cerebrovascular accident (CVA), underwent a cadaveric examination at our medical school. On examination of the abdomen, there was an incidental finding of CMT. The arterial and venous diameters were measured, and vascular histopathology was undertaken. The vascular anatomy was consistent with CMT type 1-b. Nutcracker phenomenon (NCP) (left renal vein compression) was seen anatomically as dilatation and engorgement of the left renal vein, relative to the right renal vein (10.77±0.13 mm vs. 4.49±0.56 mm, respectively), and dilatation and engorgement of the left ovarian vein, relative to the right ovarian vein (4.37±0.15 mm vs. 1.06±0.09 mm, respectively) with left ovarian varicocele. The aortoceliac angle (ACA) and the aortomesenteric angle (AMA) approached zero degrees. CONCLUSIONS: We have described a rare anatomic finding of CMT that created an acute AMA and NCP. Awareness of this rare association between CMT and NCP by clinicians, vascular surgeons, and radiologists may be of value in the future evaluation and surgical management of patients who present clinically with ‘nutcracker syndrome.’ International Scientific Literature, Inc. 2017-12-15 /pmc/articles/PMC5742474/ /pubmed/29242494 http://dx.doi.org/10.12659/AJCR.906283 Text en © Am J Case Rep, 2017 This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) )
spellingShingle Articles
Peterson, Joshua
Hage, Anthony N.
Diljak, Stephan
Long, Benjamin D.
Marcusa, Daniel P.
Brzezinski, David W.
Eliason, Jonathan
Incidental Anatomic Finding of Celiacomesenteric Trunk Associated with ‘Nutcracker Phenomenon,’ or Compression of the Left Renal Vein
title Incidental Anatomic Finding of Celiacomesenteric Trunk Associated with ‘Nutcracker Phenomenon,’ or Compression of the Left Renal Vein
title_full Incidental Anatomic Finding of Celiacomesenteric Trunk Associated with ‘Nutcracker Phenomenon,’ or Compression of the Left Renal Vein
title_fullStr Incidental Anatomic Finding of Celiacomesenteric Trunk Associated with ‘Nutcracker Phenomenon,’ or Compression of the Left Renal Vein
title_full_unstemmed Incidental Anatomic Finding of Celiacomesenteric Trunk Associated with ‘Nutcracker Phenomenon,’ or Compression of the Left Renal Vein
title_short Incidental Anatomic Finding of Celiacomesenteric Trunk Associated with ‘Nutcracker Phenomenon,’ or Compression of the Left Renal Vein
title_sort incidental anatomic finding of celiacomesenteric trunk associated with ‘nutcracker phenomenon,’ or compression of the left renal vein
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5742474/
https://www.ncbi.nlm.nih.gov/pubmed/29242494
http://dx.doi.org/10.12659/AJCR.906283
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