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Journals
Journal of Ultrasonography
Volume 23 (2023): Issue 93 (June 2023)
Open Access
Double nutcracker syndrome in a patient with circumaortic venous ring: a rare case report
Renato Farina
Renato Farina
,
Pietro Valerio Foti
Pietro Valerio Foti
,
Lorena Nicolosi
Lorena Nicolosi
and
Antonio Basile
Antonio Basile
| May 11, 2023
Journal of Ultrasonography
Volume 23 (2023): Issue 93 (June 2023)
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Article Category:
Case report
Published Online:
May 11, 2023
Page range:
e101 - e105
Received:
Oct 13, 2022
Accepted:
Mar 16, 2023
DOI:
https://doi.org/10.15557/jou.2023.0018
Keywords
nutcracker syndrome
,
ultrasound
,
cardiovascular abnormalities
,
computed tomography
,
magnetic resonance imaging
© 2023 Renato Farina et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Fig. 1.
Diagram showing the anatomical relationships in a patient with NCS. Ao – abdominal aorta
Fig. 2.
CT of double NCS. A. In this image, the retroaortic renal vein (arrow) appears compressed between the aorta and spine. ICV: Inferior cava vein. B. This image shows the anteroaortic renal vein (short arrow) which appears compressed in the space between the aorta and superior mesenteric artery (long arrow). C. This coronal view shows gonadal vein dilatation (arrow). d: This axial view shows varicosities of the gonadal plexus (arrows)
Fig. 3.
Grayscale US of the abdominal aorta. Measurement of aortomesenteric distance and aortomesenteric angle. A. Transverse scan of the abdominal aorta shows a narrowing of the aortomesenteric space (D1) measuring 4.2 mm. Superior mesenteric artery (arrow head). Left anteroaortic renal vein (short arrow). Left retroaortic renal vein (long arrow). Abdominal aorta (Ao). Inferior cava vein (ICV). B. Longitudinal scan of the abdominal aorta shows a narrowing of the aortomesenteric angle (18°) and aortomesenteric distance (D1) measuring 4.2 mm. C. Pelvic ultrasound scans show gonadal plexus varicosities (arrows). D. Color Doppler US shows prestenotic tract of the retroaortic renal vein (short arrow) and poststenotic tract of the anteroaortic renal vein (long arrow). Ao: Abdominal aorta. E. Duplex Doppler US measure of the prestenotic flow of retroaortic renal vein. F. Duplex Doppler US measure of the poststenotic flow of retroaortic renal vein
Summary of results obtained by Doppler US
Flow ratio
Prestenotic PSV
Poststenotic PSV
Flow ratio after 1 month
Anterior LRV
2.69
18.8 cm/s
50.6 cm/s
2.4
Posterior LRV
2.75
8 cm/s
22 cm/s
2.75