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)
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…

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More from @DrJayMohan

6 Dec 20
(1/)—🅰🆁🆃🅴🆁🅸🅾🆂🅰 🅻🆄🆂🅾🆁🅸🅰

➡️Arteria Lusoria or aberrant right subclavian artery (ARSA) is the most common congenital arch anomaly in which the right subclavian artery originates from the descending aorta, distal to the left subclavian at the ductus arteriosus.
(2/)On its course towards the R arm, the aberrant vessel travels retrotracheal +retroesophageal. The prevalence of ARSA ranges from 0.6 to 1.4%. The prevalence of ARSA rises exponentially to 26–34% in individuals with Down syndrome and other chromosomal defects. Pic: @Tesslagra
(3/) Rarely, ARSA can accompany Kommerell's diverticulum, an aneurysm of the descending aorta at the origin of the ARSA. This can present clinically as dysphagia, dyspnea, or subclavian steal syndrome, often requiring surgical intervention
Read 17 tweets
15 Aug 20
(1/22) Acute PE treatment. An ever evolving landscape.

How about a #tweetorial on acute pulmonary embolism (#PE) and how to use mechanical #thombectomy with @InariMedical #FlowTriever?? Lets goooooo!

#InariFellowsEdition #IRad #IC #cardiotwitter
Pic credit @Jonathan_PaulMD Image
2/ From @CDCgov data one American dies of a blood clot every....? #VTE #PE @PERTConsortium #InariFellowsForum
3/ Acute #PE stats

📊100,000–180,000 PE-related deaths annually in US

📊PE is the most preventable cause of death among hospitalized patients

📊3rd leading cardiovascular cause of death after coronary disease and stroke

⏱ 1 American dies of a blood clot every 6 seconds Image
Read 25 tweets

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