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.

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.

Nutcracker syndrome and phenomenon

2015 ◽  
Author(s):  
John Neary ◽  
Neil Turner
Keyword(s):  
Renal Vein ◽  
Incidental Finding ◽  
Left Renal Vein ◽  
Stent Migration ◽  
Nutcracker Syndrome ◽  
Pain Syndromes ◽  
Asymptomatic Patients ◽  
Weak Evidence ◽  
Life Threatening ◽  
Postural Proteinuria

Nutcracker syndrome describes symptomatology associated with obstruction to the left renal vein caused by pressure from the overlying superior mesenteric artery. Modern imaging methods show that some degree of left renal vein obstruction may be a common incidental finding in asymptomatic patients so it is better described as ‘nutcracker phenomenon’, NCP. The association of NCP with symptoms and signs is often speculative. NCP may be seen at any age but most patients with symptoms attributed to it are teenagers or young adults. The strongest evidence is for association with episodic macroscopic haematuria. There is weak evidence that it may in some circumstances account for orthostatic (postural) proteinuria, microscopic haematuria, or pain syndromes. Apart from rare examples of extreme haemorrhage the syndrome has not been associated with life-threatening features other than through complications of treatment. Various interventions have been employed, recently most commonly endovascular or extravascular approaches to stenting the vein, but serious adverse consequences from stent migration and thrombosis have been described.

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 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.

Prevalence and Incidence of Clinical Symptoms of the Retroaortic Left Renal Vein

2015 ◽  
Vol 94 (2) ◽  
pp. 173-176 ◽  
Author(s):  
Stefan Heidler ◽  
Stephan Hruby ◽  
Stephan Schwarz ◽  
Yolanthe Sellner-Zwieauer ◽  
Wolfgang Hoeltl ◽  
...  
Keyword(s):  
Medical Records ◽  
Renal Vein ◽  
Clinical Characteristics ◽  
Ureteropelvic Junction Obstruction ◽  
Clinical Symptoms ◽  
Multidetector Ct ◽  
Left Renal Vein ◽  
Flank Pain ◽  
Rare Finding ◽  
Small Minority

Objective: To analyze the prevalence and incidence of clinical symptoms of retroaortic left renal vein (RLRV) diagnosed incidentally over 10 years by computed tomography (CT). Patients and Methods: 7,929 consecutive patients (out- and inpatients) were studied with multidetector CT from January 2000 to April 2011. We retrospectively reviewed RLRV patients' medical records and analyzed their clinical characteristics. Results: A total of 61 out of 7,929 patients had a RLRV, therefore the prevalence was 0.77%. Only 4 of 61 (6.6%) RLRV patients diagnosed by CT scan were clinically symptomatic. RLRV was associated with flank pain and microhematuria in one patient (1.6%), in another one with microhematuria only and in one with ureteropelvic junction obstruction. Furthermore, one patient suffered from arterial hypertension associated with a RLRV. Conclusions: RLRV is a rare finding, and only a small minority of RLRVs causes symptoms.

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.

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