[Ligamentum arcuatum syndrome: color doppler ultrasound diagnosis in abdominal pain of unknown origin in young patients]

Subject body mass index affects Doppler waveform in celiac artery by duplex ultrasound

OBJECTIVE

The aim of this study is to evaluate the effect of body mass index (BMI) on peak systolic velocity (PSV) recording in the celiac artery (CA).

SUBJECTS & METHODS

Forty male participants were entered prospectively into the study. The subjects were divided into two groups according to their body mass index. Group A included subjects with BMI ≤25 Kg/m(2) and those in group B with BMI >25 Kg/m(2). The diameter and PSV at the origin of CA of subjects in both groups were recorded while the subject positioned in supine and during expiration phase and fasted for 4 hours using duplex ultrasound. Both groups were matched for age and sex. Independent Student's t-test was used to test if there is any statistical significance between diameter and PSV in both groups.

RESULTS

Group A's, average age (year, ±SD) was 29.35±1.35 and average BMI (Kg/m(2), ±SD) was 23.1±1.60. Group B's, average age was 30±2.1 and their average BMI was 31±5.1. The average diameter (cm, ±SD) of CA in group A was 0.66±0.076 and in group B was 0.80±0.066. However, the average PSV (cm/s, ±SD) was 117±28.1 in group A and 102±12.4 in group B. Independent student t-test showed statistical significance between both groups for the diameter (p=0.005) and just reached statistical significance for PSV (p=0.049).

CONCLUSION

Subjects with higher BMI showed reduced PSV due to a larger CA diameter and probably due to more fatty tissue accumulation around the CA origin.

Celiac artery compression syndrome in children, adolescents, and young adults: clinical and color duplex sonographic features in a series of 59 cases

OBJECTIVE

Abdominal pain is one of the most common conditions in childhood and adolescence. Celiac artery compression syndrome (CACS) is rarely suspected in this population. We present clinical and sonographic features from a series of 59 patients with this disorder.

METHODS

A total of 3449 patients from 0 to 18 years were investigated with 7639 abdominal color duplex sonographic examinations. Celiac artery flow velocity was measured at the branching off from the aorta in inspiration, expiration, and in between. Diagnosis of CACS was made if a greater than 2-fold acceleration of peak systolic flow in the celiac artery compared to the abdominal aorta or a peak systolic velocity greater than 200 cm/s was measured in the mid position and if a variation of flow velocity occurred during respiration. In 22 cases, angiography (21 magnetic resonance angiography and 1 digital subtraction angiography) was used to prove sonographic diagnosis.

RESULTS

Fifty-nine patients (among them 81% female) from 22 months to 19 years (clustering between 14 and 17 years) fulfilling color Doppler sonographic criteria of CACS were found, for a prevalence of 1.7%. Their symptoms included, among others, abdominal pain (71%), nausea (29%), thoracic pain (22%), heartburn (17%), weight loss (15%), vomiting (15%), systolic murmur (15%), postprandial accentuation of symptoms (15%), diarrhea (14%), respiratory discomfort (14%), and syncope (12%).

CONCLUSIONS

Celiac artery compression syndrome is more prevalent than expected, and conditions not usually connected to the disease were found. Alertness to CACS is recommended, especially in patients with a combination of characteristic symptoms. Color Doppler sonography is the modality of choice for diagnosing CACS.