Thread by @DrJayMohan

1/ NAME THAT #COMPRESSIONSYNDROME

Patient with left flank pain, pelvic pain, hematuria and gonadal varices

Your only imaging modality is vascular U/S....Lets find out!

A Mohan #Tweetorial

#RPVI #cardiotwitter #irad #vascular @HadyLichaaMD @t_intheleadcoat @TheNarulaSeries

2/ What’s going on here?? First name your structures #RPVI

SMA- superior mesenteric artery
AO- Descending Aorta
Lt renal VN- left renal vein

@CHICKVIR @Jonathan_PaulMD @iRadRock @keithppereira @Vascupedia_com @DrYanLiu

3/ Save this- transverse slice at the level of the renals! So much anatomy in such a confined space

#RPVI #cardiotwitter #IRAD #Vascular #foamed #cardioed #cardiology #ultrasound #pocus

4/ Know the #anatomy

—> the left renal vein transverses ANTERIOR to the aorta UNDER the superior mesenteric artery #RPVI #cardiotwitter #IRAD #vascular

5/ The SMA can be tricky to find both on U/S and angiography

Remember that is comes off ABOVE the renals and runs in an ANTERIOR and PARALLEL course to the AORTA. #Anatomy

6/ Here’s an anatomical view to help you understand the proximity of the SMA, Aorta, and left renal vein #Cardiotwitter #anatomy #IRAD #vascular #RPVI

7/ So you got your 2D images and now you get some velocities

🔑PSV at the left renal vein is 5x⬆️ than the hilum

🔑 pressure gradient of LRV and IVC is more than 3 mm Hg (Bernoulli)

8/ What’s the syndrome!!?

#RPVI #cardiotwitter #IRAD #Vascular @VikasBhallaMD @DrYanLiu @BaoGTran @HadyLichaaMD @MarqPatton @alaa_gabi @CHICKVIR @SanChris999 @rishikumarmd @yourheartdoc1 @keithppereira @KevinShahMD @ShariqShamimMD @MusaSharkawiMD

9/ NUTCRACKER SYNDROME!!

10/ Treatment of nutcracker syndrome is controversial. Surgical approaches reported include venolysis and anterior nephropexy, renal vein bypass or interposition grafting, renocaval reimplantation, and autotransplantation.

Endovascular approaches being attempted with Stenting

11/ I love interventional cardiology but I can see why people also love #IRAD and #vascular! We have sweet jobs! Hope y’all enjoyed!!

Sources:
evtoday.com/articles/2010-…

ajronline.org/doi/abs/10.221…

ncbi.nlm.nih.gov/pmc/articles/P…

radiopaedia.org/articles/nutcr…