实时超声诊断儿童直立性蛋白尿和非肾性血尿——胡桃夹现象

在直立性蛋白尿和非肾性血尿的患儿中，应用实时超声检查出胡桃夹现象（左肾静脉压迫综合征）１５４例，其中男８０例，女７４例，年龄３￣１４岁，全部患儿于仰卧位发现左肾静脉在肠系膜上动脉（ＳＭＡ）和腹主动脉（ＡＯ）间均受压，扩张部位内径较狭窄部位宽２倍以上，脊柱后伸位站立２０分钟后宽４倍以上，最宽者达１５倍，同时ＳＭＡ与ＡＯ间夹角变小。ＬＲＶ扩张程度与其受压程度一致。本文强调各种不同体位对照检查，对确诊意     

胡桃夹现象的彩色多普勒超声诊断价值

目的 探讨彩色多普勒超声对胡桃夹现象的诊断价值。方法 对35例临床初诊胡桃夹现象的患儿，应用二维超声检查，测量仰卧位时左肾静脉狭窄部及扩张部位内径，与脊柱后伸位15—20分钟后比较，并行彩色多普勒超声检查。结果 仰卧位左肾静脉狭窄前扩张部位近端内径比狭窄处内径宽2倍以上，脊柱后伸位后宽4倍以上，最宽者达10倍。结论 彩色多普勒超声为诊断胡桃夹现象首选、简单、无创的方法。     

双功能超声对儿童胡桃夹现象的研究附647例分析

超声诊断胡桃夹现象,目前国内外尚未见有关患儿SMA与AO间夹角,LRV扩张近端倍数与流速相互关系的报道, 我们从1991年1月即开始对这方面进行研究,现报道如下。 资料及方法 资料为1991年1月～1999年9月临床疑胡桃夹现象的患儿950例,角度资料完整者647例,超声诊断胡桃夹现象阳性者〔USLRV(+)〕499例,病史最短者一天,最长者10年,其中男孩247例,女孩252例;超声诊断胡桃夹现象阳性者〔USLRV(一)〕148例,其中男孩88例,女孩60例。 所用仪器Acuson 128XP/10,电脑声像仪,探头频率3.5MHz,患儿空腹8～12小时采取不同体位,经上腹部横断面配合纵断面扫查,观察并测量左肾静脉(LRV)在肠系膜上动脉(SMA)与主动脉(AO)间受压狭窄处内经和扩张近端内经以及SMA与AO间角度(固定同一位医师进行角度测量),同时测量LRV扩张近端流速。     

超声诊断左肾静脉压迫综合征

目的:探讨超声诊断左肾静脉压迫综合征的临床价值。方法:对20例左肾静脉综合征患者用彩超在空腹状态下取平卧位、直立位和脊柱后伸位经上腹部横断面及纵断面测量左肾静脉（LRV）扩张部位与受压部位内径并计算其扩张倍数、肠系膜上动脉（SMA）与主动脉（AO）夹角角度。结果:平卧位时,患者LRV扩张倍数2.1～4.2倍,SMA与AO夹角角度10 89°～16.74°;直立位和脊柱后伸位时,LRV扩张倍数进一步增大、SMA与AO夹角角度则进一步变窄。结论:超声对左肾静脉压迫综合征的诊断准确、可重复性强,应作为首选检查方法之一。     

超声在胡桃夹现象诊断中的作用

胡桃夹综合征(NCS)又称左肾静脉压迫综合征，是走行于腹主动脉(AO)与肠系膜上动脉(SMA)间的左肾静脉(LRV)受压狭窄引起的一系侧临床症状。本文对15例患者进行超声声像图分析．以探讨超声检查对胡桃夹综合征的诊断价值：     

胡桃夹综合征超声诊断标准的研究

目的 探讨胡桃夹综合征的超声诊断标准。方法 62例患者和62例对照者平卧位、左侧卧位时于肠系膜上动脉（SMA）和腹主动脉（AO）夹角处测量左肾静脉内径（D1）,左肾静脉近肾端最宽处内径（D2）,SMA和AO夹角、血流峰值速度（Vmax）和时间平均峰值速度（Vtap）;站立15min后于站立位、站立背伸位重复测量上述指标,并根据Vmax和Vtap计算夹角处与下腔静脉间的压差（△Pv、△Ptap）,并对各种诊断标准进行对比分析。结果 胡桃夹综合征患者存在左肾静脉血液回流障碍,与其他诊断标准相比,以4mm Hg为临界值的△Ptap诊断胡桃夹综合征的准确性（95．97％）、特异性（96．77％）最高。结论 左肾静脉夹角处与下腔静脉的△Ptap是诊断胡桃夹综合征最佳的超声参数。     

彩色多普勒超声对胡桃夹综合征的诊断研究

目的:应用彩色多普勒超声研究疑似胡桃夹综合征左肾静脉各项参数指标。方法:通过对15例疑似胡桃夹结构患者进行彩色多普勒超声检查,观察肠系肠上动脉(SMA)与腹主动脉(AO)之间的夹角(β),测量左肾静脉(LRV)受压狭窄部位内径(Db)及受压扩张部位内径(Da),脉冲多普勒测量受压部位血流速度(Vb)及扩张部位血流速度(Va),站立背伸位15min后重复测量上述指标。计算两种体位下Da/Db、Vb/Va及最窄处压力阶差(△P)。结果:15例患者SMA与AO之间夹角均30度。不同体位,15例患者的LRV的Da均较Db明显增宽,Vb均较Va明显增快,△P均升高;平卧位时,Da/Db2,Vb/Va3.7,△P3;站立背伸位15min后,Da/Db3.0,Vb/Va5.5,△P5.5。结论:彩色多普勒超声可动态观察胡桃夹结构左肾静脉内径及其血流动力学变化,并可准确测量获取各项参数指标,对胡桃夹综合征的诊断及指导转归有重要意义。     

螺旋CT血管成像对胡桃夹综合征的诊断价值

目的探讨螺旋CT血管成像对胡桃夹综合征的诊断价值。方法回顾性分析5例胡桃夹综合征患者进行螺旋CT增强多期扫描,并获得后处理图像。结果5例左肾静脉压迫综合征病例均可见肠系膜上动脉（SMA）压迫左肾静脉（LRV）的征象。CT血管成像多平面重建直观地显示了LRV与SMA之间的关系结论。结论多层螺旋CT三维血管成像在胡桃夹现象具有立体直观、无创简便优点,可作为胡桃夹现象临床筛查的一种常规确诊手段,具有潜在的应用价值。     

胡桃夹综合征误诊3例分析并文献复习

胡桃夹综合征（NCS）又称左肾静脉压迫综合征，是指左侧肾静脉（LRV）在腹主动脉（AO）与肠系膜上动脉（SMA）之间受压导致肾静脉高压、出现血尿或直立性蛋白尿、左侧精索静脉曲张和腰腹痛为主的一种少见病。我院收治院前曾误诊的3例结合文献复习如下。     

彩色超声多普勒诊断18例胡桃夹综合征

胡桃夹综合征即左肾静脉压迫综合征又称胡桃夹现象,是由于先天性或后天因形体变化等原因造成的左肾静脉在经过肠系膜上动脉(SMA)和腹主动脉(AO)之间的夹角处受到挤压后,导致左肾静脉近端(靠近肾门处)扩张而引起的一系列综合征。彩色超声多普勒可以通过测量SMA和AO之间的夹角,通过脊柱后伸位试验前和试验后对左肾静脉受压处     

The influence of left renal vein entrapment on outcome after surgical varicocele repair: a color Doppler sonographic demonstration.

OBJECTIVE: To evaluate the impact of left renal vein entrapment on outcome after surgical varicocele repair using color Doppler sonography. METHODS: Eighty-four men had varicoceles on color Doppler sonography (2 right sided, 74 left sided, and 8 bilateral), which were diagnosed on the basis of a venous diameter of 3 mm or greater and venous retrograde flow in the pampiniform plexus of veins during the Valsalva maneuver or when changing from a supine to an upright position. Diagnosis of the left renal vein entrapment was based on the following criteria: antero-posterior diameter of greater than 1 cm and peak velocity of less than 15 cm/s for the left renal vein at the mid portion and anteroposterior diameter of less than 0.2 cm and peak velocity of greater than 110 cm/s (or, alternatively, a diameter ratio and peak velocity ratio of >5) for the left renal vein between the aorta and superior mesenteric artery. All patients underwent surgical varicocele repair. In postoperative follow-up, we compared the presence of left renal vein entrapment with the frequency of varicocele recurrence. RESULTS: Sixteen (19%) of 84 patients had left renal vein entrapment with a left-sided varicocele. Postoperatively (mean follow-up +/- SD, 19.3 +/- 11.7 months), 27 (32.2%) of 84 had varicocele recurrence, including all 16 patients with left renal vein entrapment and 11 (20.1%) of 68 patients without left renal vein entrapment. The varicocele recurrence rate was significantly greater in patients with left renal vein entrapment (P < .001, Fisher exact test). CONCLUSIONS: The presence of left renal vein entrapment resulted in a significantly higher varicocele recurrence rate. Patients with varicoceles should routinely be evaluated for the presence of left renal vein entrapment before surgical repair.     

Failure of left-sided implantable cardioverter defibrillator implantation due to absence of left brachiocephalic vein

Implantation of an implantable cardioverter defibrillator by the transvenous approach was impossible from the left side in a patient with on absence of the left brachiocephalic vein; the left subclavian vein was connected by a large left superior intercostal vein to the accessory hemiazygos vein that joined the azygos vein; then the blood flowed into the superior vena cava. Implantation was successfully attempted using the right-sided venous access.     

Varicocele and the testicular-renal venous route: hemodynamic Doppler sonographic investigation.

The aim of this study was to quantify the anatomic and hemodynamic components of the testicular venous drainage for the purpose of understanding their mechanisms of interacting in producing mutual effects, such as "nutcracker" phenomenon, reflux, and varicoceles. Seventy-five male subjects were studied at rest and during Valsalva maneuver. Aortomesenteric distance and angle, flow velocity in different segments of the renal veins, testicular vein diameter, and flow inversion were evaluated using standard ultrasound equipment with spectral and color Doppler capabilities. The velocity of flow in the proximal segment of the left renal vein (17.5 cm/s) was found to be significantly lower than that in both the distal left renal vein (121 cm/s) and the right renal vein (37 cm/s). The flow velocity in the proximal left renal vein decreased with decrease in the aortomesenteric distance and angle. Testicular vein diameters greater than 3 mm were statistically associated with decreased superior mesenteric artery angle. A significant association also was found between the left testicular vein diameter (in Valsalva maneuver) and inversion of flow. The decrease in flow velocity in the left renal vein proximal to the bifurcation of the superior mesenteric artery from the aorta supports the "nutcracker" theory. An association was found between the decrease of superior mesenteric artery angle and the increase in testicular vein diameter. Another association exists between the presence of reflux during Valsalva maneuver and increased testicular vein diameter. These finding were significant only for testicular vein diameter values greater than 3 mm.     

头臂静脉的CT解剖学研究

目的探讨左右侧头臂静脉的CT解剖结构差异。方法回顾性分析无纵隔、锁骨上及腋窝病变的胸部平扫及增强扫描60例,观察左右侧头臂静脉的形态,测量左侧头臂静脉横过主动脉弓或右侧头臂动脉处的短径,右侧头臂静脉汇入上腔静脉前段短径,记录静脉注射侧别、有无静脉反流。结果右侧头臂静脉短直,直行向下汇入上腔静脉(100%,60/60);左侧头臂静脉较长,跨过右侧头臂动脉前方者(Ⅰ型)占86.7%(52/60),跨过主动脉弓前方者(Ⅱ型)占13.3%(8/60)。左侧头臂静脉管径明显小于右侧,26.7%出现管腔狭窄,经左侧肘前静脉注射时,8.3%出现明显的静脉反流;右侧头臂静脉管径大于左侧,未发现静脉反流病例。结论右侧头臂静脉形态短直,管径明显大于左侧,未发现静脉反流,在CT增强时采用右侧上肢静脉注射,能达到较好的对比剂强化效应。     

Prevalence of venous anatomic variants and occlusion among patients undergoing implantation of transvenous leads

BACKGROUND: The implantation of transvenous leads may be prohibited by venous occlusion or anatomical variants. The prevalence of these conditions among patients undergoing transvenous pacing or implantable cardioverter defibrillator (ICD) leads implantation has not been systematically studied. This study examined the prevalence of venous anatomic variants and/or venous occlusion, and related risk factors, prior to lead implantation. METHOD: The study included 273 consecutive patients scheduled for implantation of transvenous pacing or ICD leads. Before the procedure, the venous network of arms, neck, and thorax was evaluated by bilateral intravenous digital subtraction angiography (DSA). RESULTS: Complete venous occlusion associated with developed collateral circulation was observed in 12 patients (4.4%); at the site of the left innominate vein in 9, left subclavian vein in 2, and right subclavian vein in 1 patient. Of 12 patients with venous occlusion, 7 patients had a history of prior surgical procedure. A persistent left superior vena cava was observed in 1 patient (0.4%). The presence of abnormal findings on DSA was significantly higher on the left than the right side (P < 0.001). The cardio-thoracic ratio (CTR) was significantly greater in patients with venous occlusions than patients with normal circulation (P = 0.012). CONCLUSIONS: Asymptomatic venous abnormalities are not rare among patients requiring transvenous pacing lead implantation. Careful attention should be paid when implanting pacing or ICD leads from the left side, especially in patients with an increased CTR or history of prior insertion for central venous catheter.     

彩色多普勒超声对左肾静脉压迫征诊断的回顾分析

目的 通过回顾分析23例左肾静脉压迫征，探讨彩超对其诊断价值。方法 23例直立性血尿和/或蛋白尿加重，肾组织穿刺活检证实无器质性疾病患者行彩色多普勒超声检查。结果 患者左肾静脉近肾段内径扩张，血流速度减慢，尤其在脊柱后伸位时加重。结论 应用彩色多普勒超声检查能较好地检查左肾静脉压迫征。为临床提供重要的临床诊断依据。     

Location of aldosterone-producing adenomas by the determination of plasma aldosterone in adrenal vein or renal vein blood.

1. Aldosterone-producing adenomas were located before operation in eighteen patients by comparison of aldosterone concentrations in blood obtained by percutaneous catheterization of the adrenal vein or renal vein. The concentration of aldosterone in the venous effluent from the adrenal glands containing adenomas was significantly greater than in the venous effluent from contralateral glands. 2. Cathetherization of the adrenal vein is, however, technically difficult. The location of adrenal adenomas was also possible by analysis of blood from the renal vein. 3. If the concentrations of aldosterone in blood from the left renal vein were higher than those from the right, the existence of a left adrenal adenoma was suggested. A high value in plasma, obtained from the inferior vena cava above the entry of the right adrenal vein, showed a right adrenal adenoma. This procedure identified very small functional adenomas which could not be demonstrated radiographically, or seen or palpated at surgery. 4. It was concluded that differential aldosterone measurement after percutaneous bilateral adrenal vein or renal vein catheterization can be used as a definitive test for the location of an aldosterone-producing adenoma, where this is uncertain.     

区域血流追踪法在超声诊断胎儿肺静脉异位引流中的应用价值

目的探讨区域血流追踪法在超声诊断胎儿肺静脉异位引流中的价值。 方法回顾性选取2015年1月至2019年12月在河北生殖妇产医院进行胎儿超声心动图检查，诊断为肺静脉异位引流的胎儿41例。超声检查胎儿肺静脉时，应用区域血流追踪法，即将肺组织大致分为4个区域，左侧前上部1/2肺野、左侧后下部1/2肺野、右侧前上部1/2肺野、右侧后下部1/2肺野，应用彩色血流技术对41例肺静脉异位引流胎儿4个区域内肺静脉分支进行追踪并定位，观察其近心端与左心房的关系及最终回流部位。 结果41例肺静脉异位引流胎儿，4个区域内肺静脉远端分支分别引流入左上肺静脉、左下肺静脉、右上肺静脉、右下肺静脉。36例完全型肺静脉异位引流胎儿4条肺静脉近心端均未汇入左心房，其中34例呈现左心房后方汇聚征。心上型25例肺静脉最终回流入上腔静脉；心内型7例中6例通过冠状静脉窦回流入右心房，1例直接回流入右心房；心下型2例肺静脉回流入门静脉窦；混合型2例，1例左侧肺静脉汇入上腔静脉，右侧肺静脉汇入下腔静脉，1例左侧肺静脉汇入上腔静脉，右侧肺静脉回流入右心房。5例部分型肺静脉异位引流胎儿，1例右上肺静脉直接回流入右心房，2例右上肺静脉回流入上腔静脉，1例右上、右下肺静脉直接回流入右心房，1例左肺静脉变异为3支，最上支经无名静脉回流入上腔静脉。 结论应用区域血流追踪法可使肺静脉分支检查更全面，定位更加精确，有助于提高胎儿肺静脉异位引流的诊断准确性。     

Side matters: An intriguing case of persistent left superior vena-cava

Persistent left superior vena cava, usually an incidental finding, is the most common thoracic vein anatomical variation draining into the coronary sinus. Central venous catheter procedures may be complicated secondary to the presence of a persistent left superior vena cava, leading to life-threatening complications such as arrhythmias, cardiogenic shock, and cardiac arrest. We present a case of persistent superior vena cava diagnosed on transthoracic echocardiogram (TTE) in a patient with congestive heart failure. A dilated coronary sinus was identified on TTE, followed by injection of agitated saline into the left antecubital vein resulting in filling of the coronary sinus prior to the right atrium-an indication of persistent left superior vena-cava. This also was confirmed on cardiac computed tomography. Such a diagnosis is critical in patients who may undergo central venous catheter procedures such as our patient’s potential requirement for an implantable cardiovertor defibrillator due to severe global left ventricular systolic dysfunction. The presence of a persistent left superior vena cava should always be suspected when the guidewire takes a left-sided downward course towards the right atrium at the level of the coronary sinus. Therefore, special attention should be paid to the imaging work-up prior to central venous catheter procedures.     

Successful treatment of massive thrombosis in different locations with prolonged thrombolytic therapy: A life-saving intervention

Venous thrombosis is recognized as one of the most important complications of nephrotic syndrome (NS). In patients with NS, venous thrombosis may develop in the renal veins, the deep veins of the lower limb, and the inferior vena cava. Here, we describe a case report of an NS patient with multiple venous thrombosis in the right renal vein, the left iliac vein, the vena cava inferior, the right atrium, and the pulmonary arteries. Moreover, we describe the successful treatment of multiple venous thrombosis with prolonged thrombolytic treatment in spite of an increased risk of bleeding due to renal biopsy.