scholarly journals Left renal vein entrapment syndrome: nutcracker syndrome!

2019 ◽  
Vol 12 (9) ◽  
pp. e230877 ◽  
Author(s):  
Louise Dunphy ◽  
Marta Penna ◽  
Emily Tam ◽  
Jihene EL-Kafsi
Keyword(s):  
Renal Vein ◽  
Left Renal Vein ◽  
Clinical Manifestations ◽  
Flank Pain ◽  
Vascular Compression ◽  
Nutcracker Syndrome ◽  
Venous Circulation ◽  
Lumbar Vein ◽  
Normal Gallbladder ◽  
Specific Symptoms

Nutcracker syndrome (NCS) is a rare vascular compression disorder that involves compression of the left renal vein most commonly between the aorta and the superior mesenteric artery (SMA), although variations exist. It is associated with the formation of the left renal vein from the aortic collar during the 6th–8th week of gestation and abnormal angulation of the SMA from the aorta. Collateralisation of venous circulation including mainly the left gonadal vein and the communicating lumbar vein are the most significant effects. It has a female predilection occurring in the third to fourth decade and it tends to be diagnosed earlier in men. Affected individuals may present with a myriad of symptoms such as haematuria, left flank pain and proteinuria. As patients often present with these non-specific symptoms to primary care, knowledge of NCS is essential. The diagnosis can be rendered with Doppler ultrasonography, retrograde venography, CT angiography, intravascular ultrasound and magnetic resonance angiography. The authors describe the case of a 39-year-old woman with a low body mass index (BMI) presenting with generalised abdominal and flank pain as well as chronic microcytic anaemia. Physical examination findings were suggestive of biliary or renal colic. Laboratory investigations confirmed her anaemia (haemoglobin 88 g/L, mean corpuscular volume (MCV) 72 fL), but were otherwise unremarkable. Urinalysis showed proteinuria and haematuria. However, ultrasonography was unremarkable with a normal gallbladder and no evidence of calculi. Her CT scan showed marked compression of the left renal vein between the aorta and the SMA (nutcracker phenomenon), with upstream left renal, left gonadal and left lumbar vein dilatation. She was managed conservatively. This paper provides an overview of the aetiology, embryology, clinical manifestations, imaging modalities and management of NCS.

scholarly journals What Each Clinical Anatomist Has to Know about Left Renal Vein Entrapment Syndrome (Nutcracker Syndrome): A Review of the Most Important Findings

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Krzysztof Orczyk ◽  
Grzegorz Wysiadecki ◽  
Agata Majos ◽  
Ludomir Stefańczyk ◽  
Mirosław Topol ◽  
...  
Keyword(s):  
Superior Mesenteric Artery ◽  
Renal Vein ◽  
Mesenteric Artery ◽  
Clinical Symptoms ◽  
Left Renal Vein ◽  
Unknown Origin ◽  
Nutcracker Syndrome ◽  
Venous Circulation ◽  
Lumbar Vein ◽  
Primary Test

Nutcracker syndrome (NCS) is the most common term for compression of the left renal vein between the superior mesenteric artery and the abdominal aorta. The development of NCS is associated with the formation of the left renal vein (LRV) from the aortic collar during the sixth to eighth week of gestation and abnormal angulation of the superior mesenteric artery from the aorta. Collateralization of venous circulation is the most significant effect of NCS. It includes mainly the left gonadal vein and the communicating lumbar vein. Undiagnosed NCS may affect retroperitoneal surgery and other radiological and vascular procedures. The clinical symptoms of NCS may generally be described as renal presentation when symptoms like haematuria, left flank pain, and proteinuria occur, but urologic presentation is also possible. Radiological methods of confirming NCS include Doppler ultrasonography as a primary test, retrograde venography, which can measure the renocaval pressure gradient, computed tomography angiography, which is faster and less traumatic, intravascular ultrasound, and magnetic resonance angiography. Treatment can be conservative or surgical, depending on the severity of symptoms and degree of LRV occlusion. Nutcracker syndrome is worth considering especially in differential diagnosis of haematuria of unknown origin.

scholarly journals Nutcracker Syndrome Complicated by Left Renal Vein Thrombosis

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Faouzi Mallat ◽  
Wissem Hmida ◽  
Mehdi Jaidane ◽  
Nadia Mama ◽  
Faouzi Mosbah
Keyword(s):  
Computed Tomography ◽  
Computed Tomography Angiography ◽  
Renal Vein ◽  
Left Renal Vein ◽  
Renal Vein Thrombosis ◽  
Flank Pain ◽  
Complete Disappearance ◽  
Nutcracker Syndrome ◽  
Rare Entity ◽  
Vein Thrombosis

Isolated renal vein thrombosis is a rare entity. We present a patient whose complaint of flank pain led to the diagnosis of a renal vein thrombosis. In this case, abdominal computed tomography angiography was helpful in diagnosing the nutcracker syndrome complicated by the renal vein thrombosis. Anticoagulation was started and three weeks later, CTA showed complete disappearance of the renal vein thrombosis. To treat the Nutcracker syndrome, we proposed left renal vein transposition that the patient consented to.

scholarly journals Left Renal Vein Stenting in Nutcracker Syndrome: Outcomes and Implications

2020 ◽  
Vol 3 ◽  
Author(s):  
Patrick Cherfan ◽  
Efthymios D Avgerinos ◽  
Rabih A Chaer
Keyword(s):  
Renal Vein ◽  
Left Renal Vein ◽  
Case Series ◽  
Flank Pain ◽  
Nutcracker Syndrome ◽  
Line Treatment ◽  
First Line ◽  
Extrinsic Compression ◽  
First Line Treatment

Nutcracker syndrome refers to the symptomatic extrinsic compression of the left renal vein presenting most commonly as flank pain and haematuria. While surgery remains the first-line treatment, stenting is gaining more acceptance and there are now several published case series. This article highlights the outcomes of left renal vein stenting in the setting of nutcracker syndrome.

scholarly journals Left Renal Vein Thrombus and Pulmonary Thromboembolism Caused by Nutcracker Syndrome: a Case Report

2021 ◽  
Author(s):  
Kanta Hori ◽  
Shota Yamamoto ◽  
Maki Kosukegawa ◽  
Noboru Yamashita ◽  
Yuichiro Shinno
Keyword(s):  
Case Report ◽  
Renal Vein ◽  
Pulmonary Thromboembolism ◽  
Case Reports ◽  
Left Renal Vein ◽  
Clinical Manifestations ◽  
Venous Hypertension ◽  
Nutcracker Syndrome ◽  
Case Presentation ◽  
Renal Venous Hypertension

Abstract Background: Nutcracker syndrome (NCS) refers to compression of the left renal vein (LRV) between the aorta and superior mesenteric artery (SMA), which results in renal venous hypertension and its resultant clinical manifestations. Left renal vein thrombus (LRVT) complicating NCS is relatively rare. To the best of our knowledge, there are only four case reports of LRVT complicating NCS. Furthermore, there are no reports of pulmonary thromboembolism (PTE) caused by NCS. Herein, we describe a rare case of NCS causing LRVT and PTE and its clinical management. Case Presentation: A 40-year-old man was admitted to our hospital with acute left flank pain. Computed tomography angiography (CTA) revealed compression of the LRV between the aorta and the SMA with an LRVT. Furthermore, CTA revealed bilateral PTE. Rivaroxaban was administered as an anticoagulant. Twenty days after initiation, CTA revealed complete resolution of PTE and LRVT, and repeat CTA at 3 and 6 months showed no recurrence. Conclusions: This case report demonstrates that NSC may be a possible cause of LRVT and PTE. We review the reported cases of NCS complicated by LRVT and discuss the imaging modalities for NCS.

scholarly journals A rare presentation of nutcracker syndrome and it’s vascular managment

2017 ◽  
Vol 7 (1) ◽  
pp. 13
Author(s):  
Nguessan Judicael Ahoury ◽  
Salami Fatima Adéniké ◽  
Ndja Ange Patrick ◽  
Cavez Nicolas ◽  
Kouassi Paul Nzi
Keyword(s):  
Renal Vein ◽  
Mesenteric Artery ◽  
Left Renal Vein ◽  
Flank Pain ◽  
Nutcracker Syndrome ◽  
Rare Presentation ◽  
Left Flank ◽  
Long Time ◽  
Angio Ct ◽  
Left Flank Pain

Nutcracker syndrome includes all the symptoms associated with the narrowing of the left renal vein (LRV). That narrowing occurs between the aorta and the Superior Mesenteric Artery (anterior) or vertebra (posterior). The symptoms are various and not specific but the patient sometimes presents hematuria with or without left flank pain. We report a case on a 42 years old woman, who was suffering from left flank pain for a long time aggravated during and after each pregnancy. The diagnosis of nutcracker syndrome was initially omitted. Abdominal pelvic Angio CT and venography were performed. We placed a percutaneous stent in the narrowed portion of the renal vein. The result was successful.

Variceal Veins Embolization and Left Renal Vein Stenting in a Patient with Combined Nutcracker and May–Thurner Syndrome

2021 ◽  
Author(s):  
Sina Aghdasi ◽  
Ali Reza Serati ◽  
Jamal Moosavi ◽  
Sepideh Emami ◽  
Mohammad Reza Movahed
Keyword(s):  
Renal Vein ◽  
Rare Case ◽  
Left Renal Vein ◽  
Treatment Options ◽  
Iliac Vein ◽  
Flank Pain ◽  
Nutcracker Syndrome ◽  
Percutaneous Interventions ◽  
Leg Edema

AbstractNutcracker syndrome is defined as a compression of left renal vein leading to symptomatic hematuria and flank pain. There are very few reports about its association with May–Thurner syndrome that is related to compression of left iliac vein causing severe leg edema. We are reporting a rare case of a patient having both conditions successfully treated with sequential percutaneous interventions. This case and treatment options are discussed in detail.

scholarly journals TREATMENT OF AORTA MESENTERIC COMPRESSION: CURRENT PROBLEMS AND PROSPECTS

2021 ◽  
pp. 36-42
Author(s):  
I. R. Nesterenko
Keyword(s):  
Ct Angiography ◽  
Doppler Ultrasound ◽  
Renal Vein ◽  
Color Doppler ◽  
Left Renal Vein ◽  
Clinical Manifestations ◽  
Color Doppler Ultrasound ◽  
Nutcracker Syndrome ◽  
Pelvic Organs ◽  
Vein Stenosis

Left renal vein compression between the aorta and the superior mesenteric artery at an acute angle of the origin of the latter (“the nutcracker syndrome”) often leads to phlebohypertension in the left renal vein causing a combination of structural and functional changes in the kidneys and pelvic organs, different clinical manifestations such as left-sided varicocele, hematuria, pelvic venous congestion syndrome, the development of renal failure. The objective of the research: to determine indications for surgical and conservative treatment of aorta mesenteric compression. Materials and methods. The study included 210 patients (142 men and 68 women) with suspected “nutcracker syndrome” who were referred to vascular surgeons for a consultation by urologists and gynecologists during the period from 1999 to 2020, mainly from the western regions of Ukraine (about 11 million population). The age of the patients ranged from 12 to 52. All patients were interviewed for specific complaints: pain in the left lumbar region and left half of abdomen, inability to eat large amounts of food, hematuria, proteinuria, hemospermia, erectile dysfunction, left sided varicocele in men, and left sided pudendal varicosity and dysmenorrhea in women. All referred patients with suspected “nutcracker syndrome” underwent color Doppler ultrasound to determine the presence of pathological reflux in the left renal and gonadal veins by measuring peak systolic velocities in order to confirm or exclude that pathology. The patients with confirmed left renal vein stenosis underwent CT angiography. Results. According to color Doppler ultrasound, different degree of aorta mesenteric compression was confirmed in 138 (65.7%) patients (83 men and 55 women), critical left renal vein stenosis was observed in 35 of them. Two patients were diagnosed with the retroaortic left renal vein (“posterior nutcracker”). According to observations, clinical manifestations of AMC syndrome severe forms occurred in case of an increase in the diameter of the distal part of the LRV compared to its proximal segment by 3-6 times as well as in case of an increase in peak systolic velocity in the stenosed proximal segment by 6-14 times (by 8.7 times on average) compared to the left renal vein distal segment. Conclusions. Color Doppler ultrasound with determination of peak systolic velocities and diameters of the left renal and gonadal veins, pathological reflux in them must be the obligatory diagnostic stage in the patients with suspected AMC. The choice of treatment approach should be made taking into account clinical and laboratory indices, as well as the assessment of AMC severity according to instrumental data (ultrasound, CT angiography, MRA, etc.). The severity of pathomorphological changes in the pelvic organs and their consequences proves the need to eliminate phlebohypertension in the left renal and gonadal veins. LRV transposition proves its effectiveness in the remote postoperative period.

scholarly journals Nutcracker Syndrome Masquerading as Renal Colic in an Adolescent Athlete: A Case Report

2021 ◽  
Vol 5 (4) ◽  
pp. 415-418
Author(s):  
Ron Waldrop ◽  
Paul Henning
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Superior Mesenteric Artery ◽  
Renal Vein ◽  
Mesenteric Artery ◽  
Renal Colic ◽  
Left Renal Vein ◽  
Flank Pain ◽  
Distance Runner ◽  
Nutcracker Syndrome

Introduction: Abdominal pain and flank pain cause a significant proportion of emergency department (ED) visits. The diagnosis often remains unclear and is frequently associated with repeat visits to the ED for the same complaint. A rare cause of left upper abdominal and flank pain is compression of the left renal vein between the aorta and the superior mesenteric artery known as nutcracker syndrome. Diagnostic findings on ultrasound include increased left renal vein diameter proximal and peak blood flow velocity increase distal to the superior mesenteric artery. We describe such a patient presenting to an ED repeatedly with severe pain mimicking renal colic before the final diagnosis and intervention occurred. Case Report: A 16-year-old female, long-distance runner presented four times complaining of intractable left upper quadrant abdominal pain radiating to the left flank after exercise. On each visit urinalysis revealed proteinuria and hematuria, and on two visits abdominal computed tomography revealed no kidney stone or dilatation of the collecting system. Ultimately, she was referred to vascular surgery where Doppler ultrasonography was used to diagnose left renal vein compression. Transposition of the left renal vein improved Doppler diameter and flow measurements and eliminated symptoms. Conclusion: Emergency physicians must maintain a large list of possible diagnoses during the evaluation of abdominal and flank pain with a repetitive and uncertain etiology. Nutcracker syndrome may mimic other causes of abdominal and flank pain such as renal colic and requires appropriate referral.

Three Unusual Cases of Nutcracker Syndrome Caused by Increased Blood Flow within the Left Renal Vein

2015 ◽  
Vol 96 (4) ◽  
pp. 484-487 ◽  
Author(s):  
Caterina Gaudiano ◽  
Simone Pucci ◽  
Fiorenza Busato ◽  
Maddalena Di Carlo ◽  
Riccardo Schiavina ◽  
...  
Keyword(s):  
Blood Flow ◽  
Renal Vein ◽  
Clinical Symptoms ◽  
Left Renal Vein ◽  
Diagnostic Value ◽  
Flank Pain ◽  
Nutcracker Syndrome ◽  
Asymptomatic Patients ◽  
Gross Haematuria ◽  
Increased Blood Flow

Nutcracker syndrome (NCS) refers to the compression of the left renal vein (LRV) between the aorta and the superior mesenteric artery. It can cause both microscopic and gross haematuria, with or without flank pain. The diagnosis is often delayed in a majority of symptomatic patients. On the other hand, the use of CT in routine abdominal explorations has increased the detection of the compression of the LRV in healthy and asymptomatic patients, but its diagnostic value remains uncertain. In this paper, we report 3 cases of the NCS associated with an increased blood flow in the LRV, due to different conditions, which we believe could produce the appearance of clinical symptoms.

scholarly journals Nutcracker syndrome accompanied by hypertension: a case report and literature review

2021 ◽  
Vol 49 (1) ◽  
pp. 030006052098573
Author(s):  
Rui-feng Wang ◽  
Chun-ze Zhou ◽  
Yu-qin Fu ◽  
Wei-fu Lv
Keyword(s):  
Renal Vein ◽  
Clinical Symptoms ◽  
Color Doppler ◽  
Left Renal Vein ◽  
Plasma Renin ◽  
Color Doppler Ultrasound ◽  
Secondary Hypertension ◽  
Flank Pain ◽  
Nutcracker Syndrome ◽  
History Of

Nutcracker syndrome (NCS) refers to characteristic clinical symptoms that develop secondary to the nutcracker phenomenon (NCP), defined as compression of the left renal vein between the superior mesenteric artery and the aorta. A 22-year-old Chinese man presented with a 2-year history of hypertension and left flank pain after activity; his blood pressure fluctuated within 130–150/90–100 mmHg without treatment. He had microscopic hematuria (2+) and increased plasma renin activity. The findings of both color Doppler ultrasound and computed tomography angiography were consistent with a diagnosis of NCS. The patient had no history of familial hypertension or special medications. Secondary hypertension-related examinations showed no significant abnormalities. After placement of an endovascular stent in the left renal vein, normal blood flow resumed and the collateral circulation was reduced. Both the hypertension and flank pain were alleviated within 3 days after the intervention and did not reappear during the following 11 months. NCP/NCS accompanied by hypertension is very rare. The possibility of NCP/NCS should be considered when secondary hypertension cannot be explained by other factors. The mechanism by which hypertension is caused by NCP/NCS is rather complex and deserves further investigation.

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