[Ligamentum arcuatum syndrome: color doppler ultrasound diagnosis in abdominal pain of unknown origin in young patients].
OBJECTIVE
To assess the diagnostic potential and accuracy of CDS in the diagnosis and management of visceral artery stenosis in young patients with abdominal pain.


METHODS
126 patients < 45 y with abdominal pain were examined by CDS. Other diseases were excluded before. Systolic (Vmax.sys.) and end diastolic (Vmax.diast.) peak velocities in exspiration and inspiration were measured in the celiac (CA) and superior mesenteric artery (SMA). Vmax.syst. > 1.8 m/s in exspiration and inspiration was regarded as a respiratory fixed stenosis. This was followed by intraarterial digital subtraction angiography (i.a. DSA) including visualization of the pancreaticoduodenal artery (PDA), and, if fixed stenosis was confirmed, by operation. CDS was again performed in the follow-up.


RESULTS
CA stenosis were found in 19 patients (mean age 28.9 y). 4 were respiratory fixed, 2 combined with SMA stenoses or occlusion, all proved by i.a. DSA. The others had no evidence of fixed CA stenoses. The 4 operated patients were postoperatively immediately well. One with intermediate pain again had a stenosis in the SMA-bypass which was successfully treated by PTA. The others were treated with dietary procedures and regularly controlled by CDS.


CONCLUSIONS
Ligamentary CA stenosis in young patients is rare, but may lead to considerable abdominal pain and weight loss. Hemodynamicly significant stenoses are proved by CDS with respiratory fixed Vmax.syst. > 1.8 m/s and Vmax.diast. > or = 1 m/s; i.a. DSA often shows a retrograde perfusion of the PDA. Such patients should be treated surgically. CDS should be performed in the follow-up.
Schuler
A
A
Medizinische Klinik I, Klinikum Bayreuth.
Dirks
K
K
Claussnitzer
R
R
Blank
W
W
Braun
B
B
D015746:Abdominal Pain / Q000000981:diagnostic imaging / Q000209:etiology*; D000293:Adolescent; D000328:Adult; D001783:Blood Flow Velocity / Q000502:physiology; D002445:Celiac Artery / Q000000981:diagnostic imaging*; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008022:Ligaments / Q000000981:diagnostic imaging*; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging; D008641:Mesenteric Vascular Occlusion / Q000000981:diagnostic imaging; D012680:Sensitivity and Specificity; D018615:Ultrasonography, Doppler, Color
Das Ligamentum arcuatum-Syndrom: Farbdopplersonographische Diagnose bei unklaren Abdominalbeschwerden junger Patienten.