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: A Rare Cause of Hematuria

2006 ◽  
Vol 6 ◽  
pp. 745-746 ◽  
Author(s):  
Emmanuel C. Gorospe ◽  
Michael O. Aigbe
Keyword(s):  
Superior Mesenteric Artery ◽  
Renal Vein ◽  
Mesenteric Artery ◽  
Left Renal Vein ◽  
Nutcracker Syndrome ◽  
Renal Veins ◽  
Collecting System

Nutcracker syndrome is the compression of the left renal vein between the aorta and superior mesenteric artery. It is a rare cause of hematuria which results from the rupture of congested renal veins into the collecting system.

scholarly journals Chronic Pelvic Pain and Hematuria Associated with Posterior Nutcracker Syndrome

2020 ◽  
Vol 06 (11) ◽  
Author(s):  
Dr. L. Belkouchi ◽  
Keyword(s):  
Superior Mesenteric Artery ◽  
Pelvic Pain ◽  
Renal Vein ◽  
Mesenteric Artery ◽  
Chronic Pelvic Pain ◽  
Anatomical Variation ◽  
Left Renal Vein ◽  
Young Patients ◽  
Nutcracker Syndrome ◽  
Posterior Nutcracker Syndrome

The nutcracker syndrome is a rare syndrome in which the left renal vein is compressed between the aorta and the superior mesenteric artery or even more rarely between the aorta and vertebral body, in case of an anatomical variation of the left renal vein. It is more likely discovered within young patients presenting pelvic pain, hematuria, or varicocele. Treatments vary from conservative, to surgical or endovascular. Here we present the case of a young patient with chronic pelvic pain and hematuria, diagnosed as a posterior nutcracker syndrome.

scholarly journals Inverted Nutcracker Syndrome: A Case of Persistent Hematuria and Pain in the Presence of a Left-Sided Inferior Vena Cava

2011 ◽  
Vol 11 ◽  
pp. 1031-1035 ◽  
Author(s):  
Obi Ekwenna ◽  
Michael A. Gorin ◽  
Miguel Castellan ◽  
Victor Casillas ◽  
Gaetano Ciancio
Keyword(s):  
Inferior Vena Cava ◽  
Superior Mesenteric Artery ◽  
Renal Vein ◽  
Mesenteric Artery ◽  
Inferior Vena ◽  
Left Renal Vein ◽  
Left Kidney ◽  
Vena Cava ◽  
Nutcracker Syndrome ◽  
The Right

Nutcracker syndrome is described as the symptomatic compression of left renal vein between the aorta and the superior mesenteric artery, resulting in outflow congestion of the left kidney. We present the case of a 51-year-old male with a left-sided inferior vena cava, resulting in compression of the right renal vein by the superior mesenteric artery. Secondary to this anatomic anomaly, the patient experienced a many-year history of flank pain and intermittent gross hematuria. We have termed this unusual anatomic finding and its associated symptoms as the “inverted nutcracker syndrome”, and describe its successful management with nephrectomy and autotransplantation.

Anterior Nutcracker Syndrome with Left Gonadal Vein Varicosities on Multiphasic Computed Tomography: An Unexpected Cause of Pyeloureteral Junction Obstruction

2015 ◽  
Vol 97 (4) ◽  
pp. 482-484
Author(s):  
Maddalena Di Carlo ◽  
Caterina Gaudiano ◽  
Fiorenza Busato ◽  
Simone Pucci ◽  
Riccardo Schiavina ◽  
...  
Keyword(s):  
Superior Mesenteric Artery ◽  
Renal Vein ◽  
Mesenteric Artery ◽  
Left Renal Vein ◽  
Nutcracker Syndrome ◽  
Left Flank ◽  
Gonadal Vein ◽  
Renal Hilum ◽  
Left Flank Pain ◽  
Uncommon Complication

The anterior nutcracker syndrome is defined by the compression of the left renal vein between the aorta and superior mesenteric artery, usually related to the occurrence of hematuria. We report the case of an uncommon complication of the nutcracker syndrome. A 75-year-old woman was referred to our institution for left flank pain without hematuria. Multiphasic computer tomography urography showed a condition of left renal vein entrapment between the aorta and superior mesenteric artery with the development of left gonadal vein varicosities at the level of the renal hilum; a pyeloureteral junction compression with dilation of the pyelocalyceal system coexisted. To our knowledge, this is the first report of the association between nutcracker syndrome and pyeloureteral junction obstruction.

scholarly journals A Case of the Nutcracker Syndrome Developed after Delivery

2014 ◽  
Vol 2014 ◽  
pp. 1-3
Author(s):  
Koji Tsumura ◽  
Kanae Yoshida ◽  
Sachi Yamamoto ◽  
Sayuri Takahashi ◽  
Katsuyuki Iida ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Superior Mesenteric Artery ◽  
Renal Vein ◽  
Mesenteric Artery ◽  
Left Renal Vein ◽  
Ureteral Orifice ◽  
Nutcracker Syndrome ◽  
Gross Hematuria ◽  
First Report ◽  
Enhanced Computed Tomography

We report a case of nutcracker syndrome that developed after delivery. A 32-year-old woman visited our clinic complaining of gross hematuria 4 months after delivery. Urethrocystoscopic examination failed to show hematuria coming from the ureteral orifice; however, enhanced computed tomography revealed the compression of the left renal vein between the aorta and superior mesenteric artery. Therefore, we diagnosed her with nutcracker syndrome and conservatively observed her. The macrohematuria disappeared by itself after 1 month. This is the first report to describe a case of nutcracker syndrome that developed after delivery.

scholarly journals Our Clinical Experiences in Patients with Nutcracker Syndrome

2021 ◽  
Author(s):  
Hatice Sonay Yalçın Cömert ◽  
Elif Bahat Özdoğan ◽  
Sema Tural Bozoğlu ◽  
Gül Şalcı ◽  
Haluk Sarıhan ◽  
...  
Keyword(s):  
Superior Mesenteric Artery ◽  
Renal Vein ◽  
Mesenteric Artery ◽  
Left Renal Vein ◽  
Rare Condition ◽  
Nutcracker Syndrome ◽  
Clinical Experiences ◽  
Orthostatic Proteinuria ◽  
The Mean ◽  
Age Range

INTRODUCTION: Nutcracker syndrome (NCS) is a rare condition caused by the compression of the left renal vein between the abdominal aorta and superior mesenteric artery. The purpose of the study was to evaluate our management of NCS. METHODS: Patients were retrospectively reviewed and sex, age, main symptoms at application, physical examination, radiological findings, laboratory examinations, and treatment were recorded. RESULTS: 23 patients (16 girls, 7 boys; age range, 5 to 16) diagnosed with NCS. Microhematuria was detected with 14 (60.8%) patients before diagnosis. And four of 9 (39.1%) were determined after diagnosis. Microhematuria was not detected in 5 (21.7%) of the patients. All patients (100%) had orthostatic proteinuria. 17 (73.9%) patients had mild, 3 (13.0%) patients had moderate and 3 (13.0%) had severe proteinuria. The mean diameter of the left renal vein (LRV) at the aortomesenteric (AM) portions and the hilar were 1.69mm±0.70 and 8.01mm±2.27. The mean angle between the superior mesenteric artery and LRV was 25.26º±7.98. DISCUSSION AND CONCLUSION: In the case of especially colic flank pain, hematuria, and proteinuria NCS should keep in mind in the differential diagnosis. Surgical management may supply more enough clinic improvement when the patient has a response to medical therapy.

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 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.

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