Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- Acknowledgment
- Section 1 Head and neck
- Section 2 Thoracic imaging
- Section 3 Cardiac imaging
- Section 4 Vascular and interventional
- Case 33 Lower extremity ischemia due to homocystinuria
- Case 34 Iatrogenic pathology masquerading as an artifact
- Case 35 Fibromuscular dysplasia
- Case 36 Traumatic vertebral arteriovenous fistulae
- Case 37 Colonic perforation during intussusception reduction
- Case 38 Juvenile nasopharyngeal angioma
- Case 39 Small bowel fistula complicating perforated appendicitis: successful treatment with tissue adhesive
- Case 40 Extrahepatic collateral arterial supply to hepatocellular carcinoma
- Case 41 Use of a curved needle to access an otherwise inaccessible abscess
- Case 42 Umbilical venous catheter malposition
- Case 43 Middle aortic syndrome
- Section 5 Gastrointestinal imaging
- Section 6 Urinary imaging
- Section 7 Endocrine - reproductive imaging
- Section 8 Fetal imaging
- Section 9 Musculoskeletal imaging
- Index
- References
Case 43 - Middle aortic syndrome
from Section 4 - Vascular and interventional
Published online by Cambridge University Press: 05 June 2014
- Frontmatter
- Contents
- List of contributors
- Preface
- Acknowledgment
- Section 1 Head and neck
- Section 2 Thoracic imaging
- Section 3 Cardiac imaging
- Section 4 Vascular and interventional
- Case 33 Lower extremity ischemia due to homocystinuria
- Case 34 Iatrogenic pathology masquerading as an artifact
- Case 35 Fibromuscular dysplasia
- Case 36 Traumatic vertebral arteriovenous fistulae
- Case 37 Colonic perforation during intussusception reduction
- Case 38 Juvenile nasopharyngeal angioma
- Case 39 Small bowel fistula complicating perforated appendicitis: successful treatment with tissue adhesive
- Case 40 Extrahepatic collateral arterial supply to hepatocellular carcinoma
- Case 41 Use of a curved needle to access an otherwise inaccessible abscess
- Case 42 Umbilical venous catheter malposition
- Case 43 Middle aortic syndrome
- Section 5 Gastrointestinal imaging
- Section 6 Urinary imaging
- Section 7 Endocrine - reproductive imaging
- Section 8 Fetal imaging
- Section 9 Musculoskeletal imaging
- Index
- References
Summary
Imaging description
A 12-year-old girl presented with acute abdominal pain. She had undergone chemo and radiation therapy seven years previously for metastatic neuroblastoma. The patient had experienced other, less severe episodes of abdominal pain over the past several months. On clinical examination she had diffuse abdominal pain, hypertension, and non-palpable femoral pulses. A CT scan demonstrated severe narrowing of the infrarenal abdominal aorta as well as occlusions of the celiac trunk, superior mesenteric artery (SMA), left renal artery, and focal narrowing of the proximal right renal artery (Fig. 43.1). The patient underwent a right renal artery angioplasty and right aortorenal bypass surgery.
Importance
Middle aortic syndrome (MAS) is a clinicopathologic term referring to significant, segmental tubular narrowing of the suprarenal, inter-renal, or infrarenal abdominal aorta, frequently associated with concomitant stenoses in the renal and visceral arteries. Ultrasound with Doppler and flow velocity investigations can directly detect the stenosis itself and demonstrate increased flow velocity and mono- or biphasic waveforms of arteries distal to the stenosis (as opposed to the normal triphasic waveforms). CT or MR angiographies can confirm the diagnosis. It is important to consider the possibility of MAS in specific patient populations and in the setting of classical clinical symptoms, described in more detail below. MAS can lead to a series of severe complications, including cerebral hemorrhage, cardiac infarctions, renal insufficiency, and mesenteric ischemia/infarction.
- Type
- Chapter
- Information
- Pearls and Pitfalls in Pediatric ImagingVariants and Other Difficult Diagnoses, pp. 193 - 195Publisher: Cambridge University PressPrint publication year: 2014