E2134. Make an Impression: A Primer on Pediatric Vascular Rings, Slings, and Abdominopelvic Vascular Compression Syndromes
  1. Michelle LaRosa; Westchester Medical Center
  2. Quan Nguyen; Westchester Medical Center
  3. Timothy Diestelkamp; Westchester Medical Center
  4. Daniel Kadosh; Westchester Medical Center
  5. Milana Flusberg; Westchester Medical Center
  6. Adele Brudnicki; Westchester Medical Center
  7. Richard Hong; Westchester Medical Center
Vascular structures can compress or be compressed by adjacent anatomic structures. In the chest, congenital anomalies of the aorta, great vessels and pulmonary artery may form vascular rings and slings that can cause compression of the adjacent esophagus and trachea. Patients often present in childhood with vague symptoms of feeding difficulty, dysphagia, respiratory distress, and stridor. In the abdomen and pelvis, the aorta and its branches can compress the duodenum, left renal vein, left common iliac vein, or the ureter, which can lead to nonspecific presentations such as nausea and vomiting, abdominal pain, flank pain, leg pain, or urinary tract infection. Radiological evaluation plays an important role in diagnosis and management of these symptoms. Severely symptomatic patients may require surgical treatment.

Educational Goals / Teaching Points
Review of embryologic development of vascular rings and slings. Review of anatomy in abdominopelvic vascular compression syndromes. Demonstrate key findings on various imaging modalities, such as fluoroscopy, CT, MR, and US. Discuss typical clinical presentation and treatment of these syndromes.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Schematic review of embryology and anatomy in vascular rings and slings, including double aortic arch, right aortic arch, and left aortic arch with aberrant right subclavian artery. Schematic review of anatomy in abdominopelvic vascular compression syndromes, including superior mesenteric artery syndrome, Nutcracker syndrome, Median arcuate ligament syndrome (MALS), May-Thurner syndrome, and ureteropelvic junction obstruction. Case-based discussion of these syndromes, incorporating different image modalities, including fluoroscopy, CT, MR, and US.

After reviewing this educational exhibit, readers will be able to describe the pathogenesis and anatomy of vascular rings, slings, and abdominopelvic vascular compression syndromes; recognize key imaging features of these syndromes on different imaging modalities; discuss clinical signs and symptoms of these syndromes.