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- Vascular Compression Syndromes
- Do you have questions?
- Checklist vascular compression syndromes
- Description of your symptoms
- Researchers from the Mayo Clinic confirm my concept of the Midline Congestion Syndrome
- Musculoskeletal pecularities of female puberty
- Lordosis /Swayback- Origin of many abdominal compression syndromes
- Nutcracker-Syndrome is a misnomer! Lordogenetic left renal vein compression is a more appropriate name!
- May-Thurner-constellation (May-Thurner-syndrome, Cockett’s syndrome)
- Midline (congestion) syndrome
- Pelvic congestion syndrome
- Celiac Trunk Compression / Dunbar syndrome / MALS / Arcuate ligament syndrome
- Wilkie-Syndrome / Superior-mesenteric-artery-syndrome
- Evlauation of vascular compressions with the PixelFlux-method
- Connective tissue disorders predispose to multiple compressions
- Postural tachycardia syndrome (POTS) – the hemodynamic consequence of vascular compression syndromes and loose connective tissue
- Restless legs-a little known symptom of abdominal vascular compression syndromes
- Pudendal neuralgia in vascular compression syndromes
- Migraine and Multiple Sclerosis
- Treatment of vascular compression syndromes
- Fatal errors in the treatment of vascular compression syndromes
- Risks of stents in venous compression syndromes
- Surgical treatment of abdominal compression syndromes: The significance of hypermobility‐related disorders
- Nutcracker and May-Thurner syndrome: Decompression by extra venous tube grafting and significance of hypermobility related disorders
- Our surgical treatment of vascular compressions
- Vascular compression syndromes I recently detected
- Detection of a new compression syndrome : Bilateral compression of the internal iliac vein between the psoas muscle and the internal iliac artery in a patient with chronic penile pain
- Diaphragmatic compression of the hepatic veins – a novel compression syndrome
- Post-prandial pain in the right upper abdomen due to a newly detected compression syndrome of the right renal vein
- A new sonographic sign of severe orthostatic venous pooling
- Gradually increasing, unbearable pain in the left flank only when standing or sitting – first description of a new compression syndrome
- A rare variant of Wilkie syndrome
- Kaleidoscope of instructive cases
- POTS – different from what you might think: an example
- Severe ataxia in a young woman with severe spinal congestion – complete resolution after decompression of the left renal vein
- Enigma resolved: vomiting during hip stretching
- Swollen bluish feet nausea unbearable epigastric and breast pain plus breathlessness
- Muscle cramps caused by a posture dependent pubic compression of the femoral artery
- Unbearable orthostatic pain in the autotransplanted left kidney
- Unbearable abdominal pain only while standing – easily diagnosed with PixelFlux
- Gradually increasing, unbearable pain in the left flank only when standing or sitting – first description of a new compression syndrome
- Abdominal pain due to liver compression in slipping rib syndrome in an EDS patient
- Genital and sexual symptoms of vascular compression syndromes – patient with ulcer of labia minora
- Posture dependent left flank / thoracic / lumbar pain – a new compression syndrome I recently detected
- Posture dependent unbearable breathlessness and fullness in the right upper abdomen due to a variable diaphragmatic compression of the hepatic veins and the vena cava inferior
- Migraines may develop in the wake of vascular compression syndromes
- Diaphragmatic compression of the liver veins with hepatic and intestinalis congestion
- Ultrasound Diagnostics
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- Perfusion Measurement – PixelFlux-method
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- Nutcracker and May-Thurner syndrome: Decompression by extra venous tube grafting and significance of hypermobility related disorders
- Papers authored by Th. Scholbach
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- Inauguration of measurements of the tissue pulsatility index in renal transplants
- From nutcracker phenomenon to midline congestion syndrome and its treatment with aspirin
- First sonographic tissue perfusion measurement in renal transplants
- First sonographic bowel wall perfusion measurement in Crohn disease
- First sonographic renal tissue perfuison measurement
- First sonographic measurement of renal perfusion loss in diabetes mellitus
- PixelFlux measurements of renal tissue perfusion
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- Vessel stretching in nephroptosis – an important driver of complaints
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Diaphragmatic compression of the liver veins with hepatic and intestinalis congestion
Increasing pain in the right hypochondrium and disturbed breathing due to a mobile diaphragmatic compression of the vena cava and the liver veins with congestion of the liver and even the small bowel
A 57 years old lady presented with unbearable pain in the right upper abdomen below the rib cage at a constant level during daytime of 8/10 which could be only suppressed by amitriptyline at night to a level allowing sleep.
The medical history revealed a pleural effusion some years ago and pneumonia residuals in the thoracic CT scans.
Striae distensae on both breasts as well as an inverted nipple on the left breast were remarkable. The auscultation of the lungs and the abdominal palpation did not reveal any specifics. The constant upper abdominal pain which was radiating from the lateral hypochondrium towards the midline and then down to the umbilicus could not be by palpation.
The ultrasound examination revealed a localized flow acceleration at the mouth of the liver veins into the vena cava exactly at the height of the diaphragm. Deep inside the liver the flow velocity in the middle hepatic vein was at maximum 25 cm/s. It increased in midposition of the diaphragm to 98 cm/s at the confluence of the liver veins. In deep inspiration as well as in deep expiration the flow velocity increased at that location. In expiration at maximum 204 cm/s were achieved whereas in deep inspiration 125 cm/s was the maximum flow velocity.
The portal flow volume changed dramatically during respiration. In midposition of the diaphragm the flow volume within the portal vein was calculated with 2249 mL/min dropping to only 823 mL/min in deep expiration whereas in inspiration 1919 mL/min could be measured. The liver was not enlarged with a height of 12.5 cm in the right medioclavicular line.
For the first time a 4D- volume flow measurement of the superior mesenteric vein was done revealing a flow volume of 138 mL/min in midposition of the diaphragm whereas in deep expiration it dropped to 82 mL/min.
The best of my knowledge this is the first description of a diaphragmatic compression of the vena cava and the liver veins which produced a measurable effect onto the venous drainage of the bowel. The patient was constipated and was suffering from decreased peristalsis and lost 8 kg of body weight.
To my knowledge, this is the first sonographic proof of functional hepatic vein compression with congestion symptoms in the liver and intestine and the first ever use of color duplex sonographic 4D volume flow measurement of a vein.
3D image of the compression of the Vena cava inferior while crossing the diaphragm
Changing shape of the VCI while crossing the diaphragm in the patient
Compression of the vena cava inferior at the mouth of the hepatic veins while crossing the diaphagm low flow inside the liver (upper left), flow acceleration at the mouth in diaphragmatic midposition (upper right), furthr flow acceleration in in- and even more in expiration (lower line)
Video of the 4D-dataset of the superior mesenteric vein – horizontal cut in the right lower corner
