CTICasesLeriche Syndrome with Nutcracker Syndrome
Imaging findings
CT angiography demonstrates aorto-iliac occlusion (Leriche syndrome) with a very small aortic lumen and complete occlusion, distal to which extensive collaterals are seen in the body wall, reconstituting the pelvic and femoral arteries with excellent distal runoff. Additionally, the superior mesenteric artery (SMA) is noted to originate at a steep angle, compressing the left renal vein between the SMA and aorta, suggestive of Nutcracker syndrome.
Key takeaways
Leriche syndrome (aorto-iliac occlusion) can be compensated by impressive collateral circulation that allows for distal vessel patency. Nutcracker syndrome involves compression of the left renal vein by the SMA and aorta, which can cause intermittent hematuria and pain. Both are significant vascular pathologies, often due to atherosclerosis.
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