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Wilkie's syndrome or superior mesenteric artery (SMA) syndrome is a rare etiology of duodenal obstruction due to compression of the third portion of the duodenum between the superior mesenteric artery and the aorta. The aorta–SMA angle ranges from 38° to 65° and the distance between the two is 10-28 mm. The main anatomical feature of SMA syndrome is the narrowing of the aorta–SMA angle to < 25° and a decrease in the aortomesenteric distance < 10 mm, causing the specific duodenal obstruction symptoms. A 17-year-old female presented in our outpatient clinic with persistent epigastric pain, early satiety, pyrosis, and weight loss (cca. 8 kg) in the last year, that had worsened at the time of presentation. An abdominal ultrasound (US) was performed after 14 hours of fasting. It revealed gastric dilatation suggesting upper gastrointestinal outlet obstruction. We admitted the patient to our hospital where we performed gastric decompression via a nasogastric tube. Blood work was unremarkable. The abdominal computer tomography (CT) suggested duodenal stenosis, while the upper gastrointestinal endoscopy revealed mild gastritis and esophagitis without an obvious obstruction. SMA syndrome was included as a differential diagnosis and we performed another abdominal ultrasound, this time measuring the angle between the aorta and SMA which was 17°, and the distance between the two was 5 mm. We also asked the radiologist to perform the same measurements on the abdominal CT performed earlier and the results were compatible with our US findings. Thus, we establish the diagnosis of SMA syndrome, and the patient was managed conservatively. Results In this case, the abdominal US has proven to be the most useful tool in establishing the diagnosis and we suggest routine measurement of the aorta-SMA angle and distance in cases suggesting upper gastrointestinal obstruction. [ABSTRACT FROM AUTHOR]

The aim of the study described here was to evaluate the reproducibility of a new shear-wave elastography (SWE) technique, 2-D SWE.GE, and the impact of ultrasound experience in acquiring reliable measurements, as no official recommendations are available for this system. Elastographic measurements (EMs) were obtained in 60 patients using 2-D-SWE with the GE Logiq E9. Three examiners with different levels of experience in ultrasound-based elastography performed 10 valid EMs on each subject: a novice (C.P.) who had no experience in liver elastography and had performed fewer than 50 ultrasound examinations; an elastography expert (A.M.S.) who had more than 1 y of liver elastographic experience in four elastographic methods and had performed more than 1000 ultrasonography examinations; and an ultrasound expert (T.M.) who had no experience in liver elastography and had performed more than 1000 ultrasound examinations. Medians and interquartile ranges were calculated (m/s). We used the inter-class correlation coefficient and Bland-Altman plots with 95% lower and upper limits of agreement to assess the inter- and intra-observer reproducibility of 2-D-SWE.GE measurements. The final study group included 60 patients, 56.7% women and 43.3% men, with a mean age of 33.08 ± 13.83 y and mean body mass index of 22.85 ± 4.04 kg/m2. In this group, 73.3% were healthy volunteers and 26.7% had compensated liver cirrhosis. We did not find significant differences between EMs taken by the examiners overall and across study groups. The overall agreement between examiners was excellent: 0.915 (95% confidence interval [CI]: 0.870-0.946). The agreement between the novice and the experienced examiners, respectively, was good to excellent (novice and ultrasound expert: 0.908, 95% CI: 0.846-0.945; novice and elastography expert: 0.885, 95% CI: 0.808-0.931). The intra-observer reproducibility for each of the examiners was excellent; however, the inter-class correlation coefficients were higher for the examiners more experienced in elastography: 0.936 (95% CI: 0.896-0.963) versus 0.966 (95% CI: 0.943-0.980) versus 0.984 (95% CI: 0. 973-0.991). The good ICCs for the median values indicate that 2-D-SWE.GE is a reproducible method. Ultrasound experience did not significantly influence the results. [ABSTRACT FROM AUTHOR]