We report a case of Dunbar syndrome, May–Thurner syndrome and Nutcracker syndrome diagnosed in one patient with clinical presentation and imaging findings on Doppler ultrasonography. Dunbar syndrome or truncus coeliacus compression syndrome is an under-diagnosed vascular compression syndrome with a lot of controversy around it because of insufficient differentiation from celiac artery stenosis. May–Thurner syndrome or iliac vein compression syndrome is an anatomically variable condition of venous outflow obstruction caused by extrinsic compression by the right common iliac artery as it crosses the iliac vein anteriorly. In Nutcracker syndrome due to compression the outflow from the left renal vein into the inferior vena cava is obstructed. The combination of all these syndromes in one patient was not described before.
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Ananthan, K., Onida, S., Davies, A. H. (2017). Nutcracker syndrome: An update on current diagnostic criteria and management guidelines. Eur. J. Vasc. Endovasc. Surg., 53 (6), 886–894.
Baskan, O., Kaya, E., Gungoren, F. Z., Erol, C. (2015). Compression of the celiac artery by the median arcuate ligament: Multidetector computed tomography findings and characteristics. Can. Assoc. Radiol. J.,66 (3), 272–276.
Boyer, K., Filan, E., Ching, B., Rooks, V., Kellicut, D. (2018). Nutcracker syndrome in adolescent with perineal pain. Radiol. Case Rep., 13 (1), 161–166.
Demir, M. C., Kucur, D., Cakir, E., Aksu, N. M. (2016). May–Thurner syndrome: A curious syndrome in the ED. Amer. J. Emerg. Med., 34 (9), 1920.
Desmond, C. P., Roberts, S. K. (2004). Exercise-related abdominal pain as a manifestation of the median arcuate ligament syndrome. Scand. J. Gastroenterol.,39 (12), 1310–1313.
Feldman, M., Friedman, L. S., Brandt, L. J. (2015). Sleisenger and Fordtran’s Gastrointestinal and Liver Disease, Vascular Disorders of the Gastrointestinal Tract. Saunders Elsevier, Philadelphia, pp. 617–635.
Hartung, O., Grisoli, D., Boufi, M., Maran, M., Hakam, Z., Barthelemy, P., Alimi, Y. S. (2005). Endovascular stenting in the treatment of pelvic vein congestion caused by nutcracker syndrome: Lessons learned from the first five cases. J. Vasc. Surg.,42 (2), 275–280.
Herman, A., Bhattacharjee, M., Maneevese, N., Desai, B. P., Pillai, A. K., Heredia, D. L. (2018). Concomitant asymptomatic May–Thurner and symptomatic Nutcracker syndrome: Is iliac vein stenting essential? J. Amer. Coll. Cardiol.,71 (11), 2180.
Ilica, A. T., Kocaoglu, M., Bilici, A., Ors, F., Bukte, Y., Senol, A., Vcoz, T., Somuncu, I. (2007). Median arcuate ligament syndrome: Multi detector computed tomography findings. J. Comput. Assist. Tomogr.,31 (5), 728–731.
Karaveliošlu, Y. (2015). Dunbar syndrome as an unusual cause of exercise-induced retrosternal pain. Turk. Kardiyol. Dern. Ars., 43 (5), 465–467.
Kuo-Kang, F., Chun-Yang, H., Hsiao, C. Y., Lee, T. H., Kuo, T. T., Shih, C. C., Hsu, C. P. (2013). Endovascular stenting for nutcracker syndrome. J. Chin. Med. Assoc.,76 (6), 350–353.
Kurklinsky, A., Shepherd, R. (2009). A case of combined nutcracker and May–Thurner Syndromes in an adult with resolution of hemodynamic findings. In: XVI World Meeting of the International Union of Phlebology; 31 August–4 September, 2009, Principality of Monaco, France, pp. 7–10.
Linares, P., Vivas, S., Dominguez, A., Jorquera, F., Munoz, F., Espinel, J., Herrera, A., Olcoz, J. L. (2002). An uncommon association of abdominal vascular compression syndromes: Dunbar and Nutcracker. Eur. J. Gastroenterol. Hepatol.,14 (10), 1151–1153.
Mousa, A. Y., AbuRahma, A. F. (2013). May Thurner Syndrome: Update and Review. Ann. Vasc. Surg.,27 (7), 984–995.
Scholbach, T. (2006). Celiac artery compression syndrome in children, adolescents, and young adults: clinical and color duplex sonographic features in a series of 59 cases. J. Ultrasound Med.,25 (3), 299–305.
Srisajjakul, S., Prapaisilp, P., Bangchokdee, P. (2017). Imaging features of vascular compression in abdomen: Fantasy, phenomenon, or true syndrome. Indian J. Radiol Imaging,27 (2), 216–224.
Stanley, J. C., Veith, F., Wakefield, T. W. (2014). Celiac Artery Compression Syndrome. Current Therapy in Vascular and Endovascular Surgery. 5th edition, Elsevier Health Sciences, London, 1940 pp. (at pp. 733–736).
Torres, O. J. M, Gama-Filho, O. P., Torres, C. C. S., Medeiros, R. M., Oliveira, C. M. B. (2017). Laparoscopic treatment of Dunbar syndrome: A case report. Int. J. Surg. Case Rep.,37, 230–232.
Tracci, M. C. (2015). Median arcuate ligament compression of the mesenteric vasculature. Tech. Vasc. Interv. Radiol.,18 (1), 43–50.
Velasquez, C. A., Saeyeldin, A., Zafar, M. A., Brownstein, A. J., Erben, Y. (2018). A systematic review on management of nutcracker syndrome. J. Vas. Surg. Venous Lymph. Disord.,6 (2), 271–278.
Xian-Ming, W., Xian-Ping, H., Guo-Liang Z. (2018). Celiac artery compression syndrome evaluated with 3-D contrast-enhanced ultrasonography: A new approach. Ultrasound Med. Biol.,44 (1), 243–250.
Yves, S. A., Hartung, O. (2014). Iliocaval Venous Obstruction: Surgical Treatment. Rutherford’s Vascular Surgery, Chapter 61. Saunders Elsevier, Philadelphia, 2570 pp. (pp. 928–954).
Zhou, Q., Lee, B., Lee, R., Stewart, M. (2015). An atypical cause of extensive left-lower-extremity DVT: May–Thurner syndrome. Radiology Case Reports,10 (2), 1–4.