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The median arcuate ligament syndrome (MALS) is a rare disease characterized by abdominal pain caused by the external compression of the celiac artery by the median arcuate ligament. Surgical treatment is indicated, but given the non-specific symptoms, these patients are often hospitalized in the Departments of Internal Medicine where the diagnosis may be unknown. We present a case of MALS admitted to our Internal Medicine Division. An abdominal ultrasound in a woman with longstanding abdominal pain showed elevated celiac artery velocities during forced expiration. Computed tomography angiography (CTA) of the abdomen showed stenosis of the origin of the celiac artery and confirmed the diagnosis of MALS. MALS is a syndrome that has to be considered, especially in young women with abdominal pain of unclear etiology; evaluated by color Doppler ultrasound, in the presence of elevated hepatic artery velocities during forced expiration, the confirmatory test is CTA.

A 73-year-old female patient underwent transradial coronary angiography with stable angina and signs of significant myocardial ischemia revealed by exercise stress test. After insertion of a 6F radial sheath into the right radial artery and intra-arterial administration of heparin plus verapamil, the hydrophilic guidewire could not be advanced under fluoroscopic guidance. Immediately afterwards, radial angiography was performed, which displayed a radial artery perforation with significant contrast extravasation. The perforated segment was crossed meticulously with the same guidewire after additional vasodilator drug administration. Afterwards, a 5F TIG catheter was advanced to the axillary artery and held in place for 20 minutes with application of external compression with a sphygmomanometer cuff at the level of systolic blood pressure. The same maneuver was again performed following cuff deflation and completion of coronary angiography with the 5F catheter. Final angiography displayed complete sealing of the perforation without a need for neutralization of heparin. External compression was continued for two hours, and after documentation of normal triphasic radial artery flow by Doppler ultrasound (DUS), the radial sheath was removed. The patient was discharged the following day with no evidence of hand ischemia and wellpalpable radial artery pulse. DUS demonstrated normal radial artery flow one month later. This unusual complication was managed successfully with a simple and easily applicable technique that can be performed in such cases.

Systemic atherosclerosis is a condition which progresses with age, decreases quality of life, and life expectancy. Lower extremity peripheral arterial disease (PAD) is a common manifestation of systemic atherosclerosis in the elderly. These individuals have a 2 to 4 fold higher risk of coronary heart disease and stroke. In addition, systemic atherosclerosis causes overall functional disability including restricted lower extremity movements. When used alone for diagnostic purposes, claudication is an unreliable sign of PAD in all age groups especially the elderly. Moreover, claudication is difficult to define due to the advancing age and degenerative changes in lumbar and peripheral joints. Doppler ultrasonography (US) is an easily available and noninvasive means of arterial visualization in the lower extremities. In this review, supporting evidence for the use of Doppler US in the diagnosis of PAD will be discussed. Past and present recommendations regarding Doppler US in the current PAD guidelines will be overviewed.

Background: Deep vein thrombosis is a multi causal disease and its one of most common venous disorder, but only one quarter of the patients who have signs and symptoms of a clot in the vein actually have thrombosis and need treatment .The disease can be difficult to diagnose. Venous ultrasound in combination with clinical finding is accurate for venous thromboembolism, its costly because a large number of patients with suspicious signs and symptoms. Venography still the gold standard for venous thromboembolism but it is invasive. The D-dimer increasingly is being seen as valuable tool rolling out venous thromboembolism and sparing low risk patients for further workup.Objectives: this study has designed the role of D-dimer to confirm diagnosis of deep vein thrombosis for patients with positive Doppler and those show no features of thrombosis in Doppler using more accurate and sensitive instrument measuring the concentration of D- dimer.Methods: Thirty patients with deep vein thrombosis diagnosed by Doppler and clinical signs and symptoms (for those with negative Doppler) assessed for D- dimer by automachine cormy accent 200 based on immunoassay which more sensitive than the ordinary methods.Results: Twenty-eight patients out of thirty shows a significant elevation of D-dimer compared to control group which show no elevation in D- dimer level. On other side higher level of D- dimer found in those with negative Doppler as same as level to the patients with positive Doppler.Conclusion: Patients with clinical sign and symptoms of deep vein thrombosis and negative Doppler should be assessed for D- dimer using more sensitive technique based on immunological assay.Key words: deep vein thrombosis (DVT) pulmonary embolism (PE), Doppler