Nutcracker Syndrome as an Unusual Cause of Postprandial Pain

2019 ◽  
Vol 54 (3) ◽  
pp. 283-285
Author(s):  
Krystal C. Maloni ◽  
Keith D. Calligaro ◽  
William Lipshutz ◽  
Kunal Vani ◽  
Douglas A. Troutman ◽  
...  
Keyword(s):  
Inferior Vena ◽  
Varicose Veins ◽  
Left Renal Vein ◽  
Vena Cava ◽  
Oral Intake ◽  
Flank Pain ◽  
Nutcracker Syndrome ◽  
Left Flank ◽  
Postprandial State ◽  
Left Flank Pain

Nutcracker syndrome is a rare entity in which compression of the left renal vein (LRV), usually by the overlying superior mesenteric artery (SMA), results in renal venous congestion and reflux in the left ovarian vein (LOV). Patients may present with hematuria, left flank pain, dyspareunia, and vaginal or abdominal wall varicose veins. We report a patient with nutcracker syndrome who presented atypically with left flank pain that was exacerbated in the postprandial state. We hypothesize that the physiologic dilation of the SMA after oral intake caused increased LRV compression at that site and augmented lateral LRV distention. The patient had no evidence of SMA syndrome or chronic mesenteric insufficiency. Her symptoms resolved after we performed an LOV to inferior vena cava transposition.

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.

scholarly journals Reno-iliac intrasystem anastomoses of the inferior vena cava

2020 ◽  
Vol 21 (2) ◽  
pp. 51-57
Author(s):  
A. A. Kapto
Keyword(s):  
Inferior Vena Cava ◽  
Collateral Circulation ◽  
Inferior Vena ◽  
Varicose Veins ◽  
Left Renal Vein ◽  
Vena Cava ◽  
Nutcracker Syndrome ◽  
Study Objective ◽  
Testicular Vein ◽  
X Ray

The study objective is to describe the anastomoses between the left renal and iliac veins in the inferior vena cava system and to classify these anastomoses.Materials and methods. From 2015 to 2020, 340 men with varicose veins of the pelvic organs and bilateral varicocele were examined. Delayed imaging for 10–30 s with phlebotesticulography of 157 patients allowed us to study in more detail the vascular venous x-ray anatomy of the scrotum and various options for collateral circulation.Results. The data obtained by us during phlebography allowed us to offer our own classification of anastomoses between the left renal vein and the common iliac vein in the inferior vena cava system (reno-iliac intrasystemic anastomoses of the inferior vena cava): 1) through the vein of the vas deferens (v. ductus deferens), 2) through the cremasteric vein (v. cremasterica), 3) through the external testicular vein (v. testicularis externa). In addition to the classification, the terms for specific types of anastomoses are also proposed by us for the first time and do not have a name in the medical scientific literature. A new definition of the term “venous anastomotic node (nodus venarum anastomoticus) of the testis and its appendage” is proposed, which describes the anatomical relationship between the 4 veins: the internal testicular vein, external testicular vein, vena cremasterica and veins of the vas deferens. A new term is proposed “pseudo-varicocele” that defines the compensatory expansion of the internal testicular vein during normal antegrade blood flow through it.Conclusion. In this work, we give an X-ray anatomical description of the development of various types of collateral circulation in the system of the inferior vena cava between the left renal vein and iliac vessels in various types of arteriovenous conflicts of both the upper (nutcracker syndrome, posterior nutcracker syndrome) and the lower level (May–Thurner syndrome).

scholarly journals Nutcracker Syndrome in Children: Role of Doppler Ultrasonographic Indices in Detecting the Pattern of Symptoms

2018 ◽  
Vol 7 (8) ◽  
pp. 214 ◽  
Author(s):  
Hulya Nalcacioglu ◽  
Meltem Ceyhan Bilgici ◽  
Demet Tekcan ◽  
Gurkan Genc ◽  
Yakup Bostanci ◽  
...  
Keyword(s):  
Renal Vein ◽  
Pediatric Patients ◽  
Left Renal Vein ◽  
Flank Pain ◽  
Nutcracker Syndrome ◽  
Macroscopic Hematuria ◽  
Presenting Symptoms ◽  
Left Flank ◽  
The Mean ◽  
Left Flank Pain

The purpose of this study was to evaluate the clinical characteristics of 44 pediatric patients who were diagnosed as having nutcracker syndrome (NCS). We also investigated the left renal vein Doppler ultrasonography (DUS) results, to determine whether or not there was an association between clinical symptoms and DUS findings among these patients. The clinical data from 44 pediatric patients who were diagnosed as having NCS from January 2008 to December 2015 were retrospectively reviewed. We grouped the patients according to the presenting symptoms as symptomatic (loin pain; macroscopic hematuria or both) and non-symptomatic (microscopic hematuria and proteinuria were detected incidentally) and evaluated the left renal vein DUS indices in these two groups separately. Asymptomatic NCS was found in 27 (61.4%) patients; 21 (47.7%) of whom were admitted for the evaluation of proteinuria. The most frequent presenting symptoms were left flank pain (20.5%) and macroscopic hematuria (13.6%); and 2 (4.5%) patients presented with a combination of left flank pain and macroscopic hematuria. The mean ratio of the diameter of the hilar portion of the left renal vein (LRV) to that of the aortomesenteric portion was 4.36 ± 1.55. The mean ratio of the peak velocity (PV) between the two sites of the LRV was 7.32 ± 2.68 (3.1–15.6). The differences in the ratio of the diameters were statistically significant between the two groups and significantly higher in children with asymptomatic NCS (p = 0.025). The PV ratios of the LRV (p = 0.035) were significantly higher in asymptomatic children with NCS than in the symptomatic group. Our study identifies that increased compression ratio of the LRV entrapment is most observed in orthostatic proteinuria and microscopic hematuria.

scholarly journals 55 year-old Female with Hematuria

2020 ◽  
Vol 4 (2) ◽  
pp. 232-233
Author(s):  
Drew Long ◽  
Brit Long
Keyword(s):  
Computed Tomography ◽  
Renal Mass ◽  
Inferior Vena ◽  
Left Renal Vein ◽  
Vena Cava ◽  
Flank Pain ◽  
Computed Tomography Scan ◽  
Case Presentation ◽  
Left Ureter ◽  
Tomography Scan

Case Presentation: A 55 year-old female presented to the emergency department with left sided abdominal pain and hematuria. Computed tomography scan of her abdomen and pelvis demonstrated a large left renal mass with extension into the left ureter, left renal vein, and inferior vena cava. She was admitted and treated for presumed renal cell carcinoma (RCC). Discussion: RCC may present with abdominal or flank pain and hematuria, but more commonly presents with vague symptoms. RCC should be suspected in a patient presenting with hematuria and abdominal or flank pain, especially if vague symptoms such as fatigue or anorexia are also present.

Nutcracker syndrome: A rare cause of left flank pain that can also manifest as unexplained pelvic pain

2017 ◽  
Vol 84 (5) ◽  
pp. 557-562 ◽  
Author(s):  
Jean-Marie Berthelot ◽  
Frédéric Douane ◽  
Yves Maugars ◽  
Eric Frampas
Keyword(s):  
Pelvic Pain ◽  
Flank Pain ◽  
Nutcracker Syndrome ◽  
Left Flank ◽  
Left Flank Pain

scholarly journals Retroperitoneal Lipoma Presenting with Nutcracker-Like Phenomenon

2013 ◽  
Vol 2013 ◽  
pp. 1-2 ◽  
Author(s):  
Seiichi Saito
Keyword(s):  
Computed Tomography ◽  
Renal Artery ◽  
Renal Vein ◽  
Left Renal Vein ◽  
Flank Pain ◽  
Left Renal Artery ◽  
Left Flank ◽  
Left Flank Pain

Retroperitoneal lipoma presenting with a nutcracker-like phenomenon is extremely rare. I experienced a case of a 65-year-old man presenting with left flank pain and macrohematuria intermittently for 3 years. Computed tomography revealed a lipoma at the left pedicle of the kidney, 30 mm in diameter, causing a curving of the left renal artery and dilatation of the left renal vein. This patient was treated successfully by retroperitoneoscopic resection of the lipoma. There have been no symptoms for 10 years after the operation.

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 Vanishing splenic cyst- visible on ultrasound but non-detected on MRI

2019 ◽  
Vol 28 (3) ◽  
pp. 262-262
Author(s):  
Cosmin Caraiani ◽  
Timothy Kurniawan ◽  
Renata Vasilache ◽  
Ciprian Brisc
Keyword(s):  
Gastric Emptying ◽  
Renal Vein ◽  
Mesenteric Artery ◽  
Delayed Gastric Emptying ◽  
Left Renal Vein ◽  
Flank Pain ◽  
Splenic Cyst ◽  
Compression Syndrome ◽  
Left Flank ◽  
Left Flank Pain

This paper ilustrates the imaging aspect of a rare pathology- aorto-mesenteric compression syndrome (Wilkie's disease). In this disease acute angulation of the superior mesenteric artery will lead to compression of the duodenum and of the left renal vein. Duodenal compression may lead to delayed gastric emptying and to nutcraker syndrome when left flank pain and hematuria may be present

scholarly journals Intraoperative Cardiogenic Shock Caused by Intracardiac Tumor Thrombi Obstruction

2020 ◽  
Vol 3 (1) ◽  
pp. 15-17
Author(s):  
Yu KP ◽  
Lin YC ◽  
Chang JY
Keyword(s):  
Inferior Vena ◽  
Left Renal Vein ◽  
Abdominal Mass ◽  
Left Kidney ◽  
Vena Cava ◽  
Large Tumor ◽  
Intracardiac Tumor ◽  
Palpable Abdominal Mass ◽  
Left Flank Pain ◽  
Tumor Thrombi

A 60-year-old man presented with left flank pain, a palpable abdominal mass, and hematuria for months. Computed tomography revealed a large tumor in the left kidney (approximately 17.7 cm in diameter) with evidence of left adrenal, left renal vein, and inferior vena cava (IVC) invasion. He underwent left nephrectomy with IVC thrombectomy. Transesophageal echocardiography (TEE) was used during the whole procedure and the tumor was found in the IVC (Fig-1) before resection.

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