0:01

Okay, so this was a case of SMA syndrome or superior mesenteric artery syndrome.

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This is a diagnosis that is made based on two factors, the decreased,

0:12

what we call aorta-mesenteric angle and aorta-mesenteric distance.

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So the angle between the superior mesenteric artery and the aorta, and then that

0:20

distance of the little fat pad between the two.

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Now, this is not a vascular compression syndrome that is primarily a vascular

0:28

issue. This happens sometimes in patients who have extreme weight loss and that

0:32

angle decreases. And so the vessels themselves are constricting, and they cause a

0:36

duodenal problem typically and can cause issues with obstruction, postprandial

0:41

abdominal pain, et cetera. This is diagnosed when you have decreased levels of

0:47

both of these. So the angle is normally between 28 and 65 degrees, and the

0:53

normal distance is anywhere from 10 to 28 millimeters.

0:57

So you can see here that we have the SMA coming off of the aorta.

1:01

This is the celiac artery above it.

1:04

And then what we can see is there's a pretty sharp turn that the SMA is taking, and

1:09

it runs almost directly next to the aorta.

1:13

So when we actually measure the angle for these, we measure that angle at the

1:18

origin for the artery, and then you can see our angle here is 16 degrees.

1:22

So that is definitely decreased. It's below the 28-degree threshold.

1:27

And then the distance here of that little fat pad is only four to five millimeters,

1:32

and so that needs to be typically at least 10 to be maintained.

1:35

So this patient met both criteria for SMA syndrome, and this can be diagnosed both

1:41

on ultrasound and with CT. It's probably more commonly diagnosed on CT.

1:46

But we can see this if the patients are coming in to be evaluated for other

1:51

etiologies as well.