case_images: PMC11831056_01
case_images: PMC11831056_02
case_images: (A) CT image showing the angle between the aorta and SMA, measuring 32.02o preoperatively. (B) CT image showing congestion and dilatation of the left gonadal vein preoperatively. SMA, superior mesenteric artery.
case_images: bcr-18-2-g001.jpg
case_images: PMC11831056_02_bcr-18-2-g001.jpg
case_images: F1
case_images: Her initial CT angiography demonstrated a reduced angle (32 ) between the SMA and aorta (normal range 38-65 ), LRV stenosis with associated prestenotic dilatation and significant dilatation of left gonadal vein with formation of pelvic collateral veins (pelvic congestion syndrome) (figure 1).
case_images: (A) Venography image showing compression of the LRV proximal to the origin of the gonadal vein with reduction of contrast flow to the IVC and flow of contrast to the dilatated left gonadal vein. (B) Venography image showing the formation of pelvic varices, post LCIV stent placement. (C) Venography image showing restoration of contrast flow in the transposed left renal vein to the IVC postoperatively. IVC, inferior vena cava; LCIV, left common iliac vein; LRV, left renal vein.
case_images: bcr-18-2-g002.jpg
case_images: PMC11831056_02_bcr-18-2-g002.jpg
case_images: F2
case_images: Selective catheterisation of the LRV distal to the origin of the left gonadal vein demonstrated reflux of contrast in the left gonadal vein and catheterisation of the proximal left gonadal vein demonstrated stasis with no evidence of antegrade flow to the LRV (Figure 2A).