Diagnostic ultrasound ( PDFDrive )

CHAPTER 12 The Retroperitoneum 455
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FIG. 12.26 Kink in Celiac Artery Caused by Median Arcuate Ligament. Aortography
shows typical appearance of kink in the celiac artery (CA) caused by the median arcuate ligament.
(A) Selective CA injection shows severe narrowing at site of the kink (arrow). (B) Gray-scale
image with patient supine shows the kink in the CA (arrow) and its relation to the superior
mesenteric artery. (C) Gray-scale image with patient supine in deep inspiration shows some
improvement in the kink. (D) Color Doppler image with patient supine shows kink causing
stenosis. (E) With patient standing, the artery becomes straightened without narrowing.
(F) Spectral image shows high velocity of 588 cm/sec with the patient in deep inspiration.
(G) With patient standing, the velocity is normal at 163 cm/sec.
to any untreated arteries that remain stenotic or occluded (e.g.,
an SMA stent placed in a patient who has an occluded celiac
artery). he stented arteries oten have increased low throughout
their course. his results in velocities that are uniformly elevated
throughout the artery. We have found this result not only in the
SMA but also in the other mesenteric arteries (Fig. 12.30).
Treatment decisions ater stenting must be made in the context
of the entire clinical picture and not on the basis of velocities
alone. If the patient is entirely asymptomatic, treatment will
generally not be undertaken regardless of the results of mesenteric
artery duplex scanning.
Iliac Veins and Inferior Vena Cava
As with veins throughout the body, the range of pathology
occurring in the iliac veins and inferior vena cava (IVC) is narrow.
hrombosis of the iliac veins and IVC is probably the most
common pathology, but is much less common than lower extremity
venous thrombosis.
Oten, the iliac veins and the infrarenal IVC are not well
evaluated directly with ultrasound. herefore ultrasound exams
are infrequently done with the intent of doing a primary evaluation
of the entire IVC and iliac veins. he main exception is infants,