From the Department of Radiology, University of California, Davis Health System, 4860 Y St, Suite 3100, Sacramento, CA 95817 (R.L., D.T.T., S.S., J.P.M., M.T.C.); and Department of Radiology, University of California, Irvine Medical Center, Irvine, Calif (C.G.L).
Radiographics. 2014 Jan-Feb;34(1):93-115. doi: 10.1148/rg.341125010.
Certain abdominopelvic vascular structures may be compressed by adjacent anatomic structures or may cause compression of adjacent hollow viscera. Such compressions may be asymptomatic; when symptomatic, however, they can lead to a variety of uncommon syndromes in the abdomen and pelvis, including median arcuate ligament syndrome, May-Thurner syndrome, nutcracker syndrome, superior mesenteric artery syndrome, ureteropelvic junction obstruction, ovarian vein syndrome, and other forms of ureteral compression. These syndromes, the pathogenesis of some of which remains controversial, can result in nonspecific symptoms of epigastric or flank pain, weight loss, nausea and vomiting, hematuria, or urinary tract infection. Direct venography or duplex ultrasonography can provide hemodynamic information in cases of vascular compression. However, multidetector computed tomography is particularly useful in that it allows a comprehensive single-study evaluation of the anatomy and resultant morphologic changes. Anatomic findings that can predispose to these syndromes may be encountered in patients who are undergoing imaging for unrelated reasons. However, the diagnosis of these syndromes should not be made on the basis of imaging findings alone. Severely symptomatic patients require treatment, which is generally surgical, although endovascular techniques are increasingly being used to treat venous compressions.
某些腹盆部血管结构可能会受到邻近解剖结构的压迫，或者可能导致邻近空腔脏器受压。这些压迫可能无症状；然而，当出现症状时，它们可能导致腹部和骨盆出现多种罕见的综合征，包括正中弓状韧带综合征、May-Thurner 综合征、胡桃夹综合征、肠系膜上动脉综合征、肾盂输尿管交界处梗阻、卵巢静脉综合征和其他形式的输尿管压迫。这些综合征的发病机制有些仍存在争议，可导致上腹痛或侧腹痛、体重减轻、恶心和呕吐、血尿或尿路感染等非特异性症状。直接静脉造影或双功能超声可提供血管受压时的血流动力学信息。然而，多层螺旋 CT 特别有用，因为它可以在一次综合研究中评估解剖结构和由此产生的形态变化。在因其他原因进行影像学检查的患者中可能会遇到易患这些综合征的解剖学发现。然而，这些综合征的诊断不应仅基于影像学发现。严重症状性患者需要治疗，通常是手术治疗，尽管血管内技术越来越多地用于治疗静脉压迫。
