scholarly journals Case report of gross hematuria in the nutcracker syndrome resolved by renocaval reimplantation

2016 ◽  
Vol 73 (12) ◽  
pp. 1178-1180
Author(s):  
Igor Banzic ◽  
Nikola Fatic ◽  
Sinisa Pejkic ◽  
Lazar Davidovic ◽  
Milos Sladojevic ◽  
...  
Keyword(s):  
Case Report ◽  
Left Renal Vein ◽  
Vena Cava ◽  
Signs And Symptoms ◽  
Nutcracker Syndrome ◽  
Gross Hematuria ◽  
Extrinsic Compression ◽  
Clinical Center ◽  
Urethral Orifice ◽  
Ventral Aorta

Introduction. Nutcracker syndrome is defined as a set of signs and symptoms secondary to compression of the left renal vein (LRV) in the acute anatomic angle between the aorta and its superior mesenteric branch. Case report. A 38-year old woman with asymptomatic and ?idiopathic? gross hematuria came to the Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia in Belgrade. Hematuria was documented by cystoscopy and was found to be unilateral, located to the left urethral orifice. The contrast-enhanced multidetector computed tomography (MDCT) scan showed a stenotic LRV due to the extrinsic compression in the angle formed by the ventral aorta and superior mesenteric artery (MSA), with a jet of contrast through the lumen. Considering the negative investigations for more common causes of hematuria, its incapacitating nature, and above mentioned imaging findings suggestive of the nutcracker syndrome, an indication for the open surgical correction of the LRV entrapment was established. The patient underwent reimplantation of the LRV into the more distal inferior vena cava (IVC), to relocate it out of the constrictive aortomesenteric space. Intraoperative findings were notable for blood flow turbulence in the LRV and hypertrophy of its tributaries, which were ligated. We presented the first published case in the Serbian literature on nutcracker syndrome with hematuria resolved by renocaval reimplantation. Conclusion. This case report demonstrates that renocaval reimplantation, as the open surgery technique, could be the adequate method for resolving gross hematuria in patients with nutcracker syndrome.

Nutcracker Syndrome: Case Report on the Management of Recurrent Stenosis After Stenting

2017 ◽  
Vol 51 (4) ◽  
pp. 203-208 ◽  
Author(s):  
Natasha Hansraj ◽  
Abdul Hamdi ◽  
Ali Khalifeh ◽  
Eric Wise ◽  
Rajabrata Sarkar ◽  
...  
Keyword(s):  
Renal Vein ◽  
Left Renal Vein ◽  
Vena Cava ◽  
Stent Migration ◽  
Venous Hypertension ◽  
Intractable Pain ◽  
Nutcracker Syndrome ◽  
Extrinsic Compression ◽  
Vein Bypass ◽  
Renal Venous Hypertension

Nutcracker syndrome is a clinical entity leading to renal venous hypertension due to extrinsic compression of the left renal vein by the superior mesenteric artery. Current surgical therapy involves placement of an oversized renal vein stent with partial protrusion into the inferior vena cava (IVC) to relieve stenosis and prevent stent migration. Here, we present a patient with intractable pain and hematuria secondary to nutcracker syndrome who underwent left renal vein stent placement and developed recurrent symptoms due to flow-limiting kinking at the left renal hilum, with partial obstruction of the IVC from pseudointimal hyperplasia. This was treated with stent excision and construction of a left neorenal vein bypass. Thus, given these complications, we should perhaps revisit the recommendations for oversizing of the stent.

scholarly journals Association of Dunbar, May-Thurner and Nutcracker Compression Syndromes in One Patient

2020 ◽  
Vol 74 (2) ◽  
pp. 150-155
Author(s):  
Poļina Zalizko ◽  
Evija Tropina ◽  
Thomas Scholbach ◽  
Aldis Puķītis
Keyword(s):  
Left Renal Vein ◽  
Vena Cava ◽  
Iliac Vein ◽  
Celiac Artery ◽  
Vascular Compression ◽  
Nutcracker Syndrome ◽  
Compression Syndrome ◽  
Extrinsic Compression ◽  
Dunbar Syndrome ◽  
Iliac Vein Compression Syndrome

AbstractWe report a case of Dunbar syndrome, May–Thurner syndrome and Nutcracker syndrome diagnosed in one patient with clinical presentation and imaging findings on Doppler ultrasonography. Dunbar syndrome or truncus coeliacus compression syndrome is an under-diagnosed vascular compression syndrome with a lot of controversy around it because of insufficient differentiation from celiac artery stenosis. May–Thurner syndrome or iliac vein compression syndrome is an anatomically variable condition of venous outflow obstruction caused by extrinsic compression by the right common iliac artery as it crosses the iliac vein anteriorly. In Nutcracker syndrome due to compression the outflow from the left renal vein into the inferior vena cava is obstructed. The combination of all these syndromes in one patient was not described before.

Retroperitoneal Laparoscopic Reimplantation of the Left Renal Vein for Nutcracker Syndrome

2014 ◽  
Vol 94 (1) ◽  
pp. 74-78 ◽  
Author(s):  
Pengfei Shao ◽  
Pu Li ◽  
Xiaobing Ju ◽  
Chao Qin ◽  
Changjun Yin
Keyword(s):  
Renal Vein ◽  
Inferior Vena ◽  
Left Renal Vein ◽  
Vena Cava ◽  
Operation Time ◽  
Nutcracker Syndrome ◽  
Gross Hematuria ◽  
Short Term ◽  
Total Operation Time ◽  
The Right

Objective: To describe the feasibility of retroperitoneal laparoscopic reimplantation of the left renal vein (LRV) for nutcracker syndrome (NCS). Patients and Methods: Two patients with NCS underwent the surgery. Both patients complained of gross hematuria and flank discomfort that could not be relieved by resting. They were placed in a supine position and 5 ports were placed in the right abdominal wall. The procedures were performed with a retroperitoneal approach. The LRV was transected and then reimplanted into the distal inferior vena cava. Results: The procedures were performed successfully without any major complications. The total operation time was 105 and 120 min, respectively. Hematuria and flank discomfort were resolved after the surgery. Ultrasonography revealed a patent lumen without compression. Conclusions: Retroperitoneal laparoscopic reimplantation of the LRV appears to be a feasible procedure with satisfactory short-term outcomes.

An Unusual Case of Pelvic Appendicitis

PEDIATRICS ◽  
1976 ◽  
Vol 58 (2) ◽  
pp. 292-293
Author(s):  
Michael A. LaCombe
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Early Diagnosis ◽  
Unusual Case ◽  
Signs And Symptoms ◽  
Memorial Hospital ◽  
Pubic Bone ◽  
Bowel Habit ◽  
Gross Hematuria ◽  
Misleading Interpretation

The atypical signs and symptoms, the misleading interpretation of symptoms by the patient's family, and the remarkable radiograph in the following case emphasize the difficulty in early diagnosis of pelvic appendicitis. CASE REPORT A 10-year-old boy came to the Emergency Department of Community Memorial Hospital, Toms River, New Jersey, complaining of pain in the pubic bone of four hours' duration. His mother thought he might have fallen on the cross-bar of his bike and was concerned about a possible fracture of the pelvis. The boy denied any nausea, vomiting, anorexia, or change in bowel habit and had no pain elsewhere. He had noticed no gross hematuria.

Iliocaval Compression Syndrome

1987 ◽  
Vol 2 (3) ◽  
pp. 173-179 ◽  
Author(s):  
Syde A. Taheri ◽  
Paul Nowakowski ◽  
David Pendergast ◽  
Julie Cullen ◽  
Steve Pisano ◽  
...  
Keyword(s):  
Iliac Artery ◽  
Common Iliac Artery ◽  
Vena Cava ◽  
Signs And Symptoms ◽  
Iliac Vein ◽  
Venous Hypertension ◽  
Common Iliac Vein ◽  
Compression Syndrome ◽  
Extrinsic Compression ◽  
The Right

The iliocaval compression syndrome is a disorder, frequently found in young women, in which extrinsic compression of the left iliocaval junction produces signs and symptoms of lower extremity venous insufficiency. The anatomic variant which gives rise to this syndrome consists of compression of the left common iliac vein by the overlying right common iliac artery, near its junction with the vena cava. Additional reduction of outflow results from intraluminal venous webs and tight adhesions between the iliac artery and vein. Pain, swelling, pigmentation, and venous claudication characterize this syndrome, which affects predominantly the left leg. The syndrome may progress to iliofemoral thrombosis, phlegmasia cerulea dolens, and venous gangrene. Longstanding iliocaval stenosis may produce valvular incompetence. Exercise plethysmography is a non-invasive test useful in screening patients for iliocaval compression. The definitive diagnosis is made by venography, both ascending and descending, to determine the degree of outflow stenosis. Iliocaval patch angioplasty with retrocaval positioning of the right iliac artery, decreases venous hypertension and leads to improvement in the clinical condition. To date, we have performed iliocaval angioplasty, with retrocaval repositioning of the right common iliac artery, on 18 patients. Of these, 83% have had good results as determined by hemodynamic and clinical assessment.

scholarly journals Imaging of Type I Retroaortic Left Renal Vein & Nutcracker Syndrome

2022 ◽  
Author(s):  
Giovanni Fontanella ◽  
Simona Borrelli ◽  
Umberto Dello Iacono ◽  
Barbara Brogna
Keyword(s):  
Left Renal Vein ◽  
Venous Hypertension ◽  
Point Of View ◽  
Type I ◽  
Nutcracker Syndrome ◽  
Renal Veins ◽  
Gross Hematuria ◽  
Renal Venous Hypertension ◽  
Symptoms And Signs ◽  
Pelvic Congestion

Retroaortic left renal veins are an often overlooked, but no so rare anatomic anomaly that might cause a few aspecific symptoms and signs, especially flank or inguinal pain, microscopic or even gross hematuria; in the vast majority of cases it is, thought, totally asymptomatic. The nutcracker syndrome that might arise in the case of RLRV is mainly due to the re- duced space between aorta and the vertebral body and the consequent compression on the venal rein; this might in turn cause upstream hypertension, hematuria, varicocele, pain. The compression of RLRV leads to hematuria because of renal venous hypertension, consequent left renal congestion. This upstream venous congestion might result, in some cases, in left-sided varicocele in men and pelvic congestion syndrome in women. From a radiologic point of view, the presence of RLRV and the precise reporting its subtypes is mandatory.

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 Spontaneous rupture of the ovarian vein in association with nutcracker syndrome: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Akihito Yamamoto ◽  
Seiryu Kamoi ◽  
Shunji Suzuki
Keyword(s):  
Computed Tomography ◽  
Abdominal Pain ◽  
Renal Vein ◽  
Spontaneous Rupture ◽  
Left Renal Vein ◽  
Vena Cava ◽  
Vascular Network ◽  
Retroperitoneal Hematoma ◽  
Nutcracker Syndrome ◽  
Ovarian Vein

Abstract Background Nutcracker syndrome is a condition in which the left renal vein is pinched between the abdominal aorta and the superior mesenteric artery, resulting in an increase in renal vein pressure and certain symptoms. We report a very rare case of retroperitoneal hematoma caused by the rupture of varicose veins of the left ovary. Case presentation A 77-year-old Japanese woman, para 7, experienced sudden left lower abdominal pain. She had no history of trauma or treatment complications. Computed tomography revealed a left retroperitoneal hematoma, but her abdominal pain subsided quickly; thus, urgent treatment was not required. We then scheduled her for an assessment regarding the cause of her bleeding. However, 6 days after the pain onset, abdominal pain symptoms recurred, confirming hematoma regrowth. Magnetic resonance imaging and three-dimensional computed tomography revealed an abnormal vascular network from the left side of the uterus to the left adnexa. Subsequent angiography revealed that the retroperitoneal bleeding originated from rupture of the distended left ovarian vein, which caused blood reflux from the left renal vein to the left ovarian vein. Although angiography confirmed a passage between the left renal vein and inferior vena cava, computed tomography showed obvious stenosis in the left renal vein. In accordance with these findings, we diagnosed the cause of the distention and rupture of the left ovarian vein as nutcracker syndrome. She underwent embolization of the left ovarian vein as hemostasis treatment, and had a good course thereafter. Conclusions This is the first report of a spontaneous rupture of the left ovarian vein caused by nutcracker syndrome. Nutcracker syndrome is not yet well known to clinicians and should be considered as part of the differential diagnosis when an abnormal vascular network in the pelvis is found.

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.

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