Nutcracker syndrome: Difference between revisions

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	Nutcracker syndrome;
DiseasesDB	32367

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Revision as of 19:06, 10 September 2012

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: nutcracker phenomenon; renal vein entrapment syndrome; mesoaortic compression of the left renal vein

Overview

Diagnosis

Radiology Studies

Nutcracker syndrome can be diagnosed with:

Left renal venography — considered to be the gold standard test.
Computed tomography (CT). The popular name "nutcracker syndrome" derives from the fact that, in the sagittal view, the SMA and AA (with some imagination) appear to be a nutcracker crushing a nut (the renal vein).
Abdominal ultrasonography — not definitive but has been found to be useful.^[1]

Treatment

Treatment depends on the severity and symptoms. Treatments include:

Endovascular stenting.^[2]
Renal vein re-implantation.^[3]
Gonadal vein embolization.^[3]

References

↑ Takebayashi S, Ueki T, Ikeda N, Fujikawa A. Diagnosis of the nutcracker syndrome with color Doppler sonography: correlation with flow patterns on retrograde left renal venography. AJR Am J Roentgenol. 1999 Jan;172(1):39-43. PMID 9888735.
↑
↑ ^3.0 ^3.1 Rudloff U, Holmes RJ, Prem JT, Faust GR, Moldwin R, Siegel D. Mesoaortic compression of the left renal vein (nutcracker syndrome): case reports and review of the literature. Ann Vasc Surg. 2006 Jan;20(1):120-9. PMID 16374539.

External links

Article on nutcracker phenomenon at the New England Journal of Medicine website.

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[1] Takebayashi S, Ueki T, Ikeda N, Fujikawa A. Diagnosis of the nutcracker syndrome with color Doppler sonography: correlation with flow patterns on retrograde left renal venography. AJR Am J Roentgenol. 1999 Jan;172(1):39-43. PMID 9888735.

[barnes_3172376-2] ↑

[rudloff_16374539-3] 3.0 ^3.1 Rudloff U, Holmes RJ, Prem JT, Faust GR, Moldwin R, Siegel D. Mesoaortic compression of the left renal vein (nutcracker syndrome): case reports and review of the literature. Ann Vasc Surg. 2006 Jan;20(1):120-9. PMID 16374539.

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[2]

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 ==Diagnosis==
-===Symptoms===
-The syndrome is associated with [[hematuria]], which can lead to [[anemia]]<ref>Oteki T, Nagase S, Hirayama A, Sugimoto H, Hirayama K, Hattori K, Koyama A. Nutcracker syndrome associated with severe anemia and mild proteinuria.
-Clin Nephrol. 2004 Jul;62(1):62-5. PMID 15267016.</ref>, [[abdominal pain|abdominal complaints or pain]]<ref name=hilgard_9721569>Hilgard P, Oberholzer K, Meyer zum Buschenfelde KH, Hohenfellner R, Gerken G. [The "nutcracker syndrome" of the renal vein (superior mesenteric artery syndrome) as the cause of gastrointestinal complaints] Dtsch Med Wochenschr. 1998 Jul 31;123(31-32):936-40. PMID 9721569.</ref> (classically left [[flank pain]]<ref name=barnes_3172376>Barnes RW, Fleisher HL 3rd, Redman JF, Smith JW, Harshfield DL, Ferris EJ. Mesoaortic compression of the left renal vein (the so-called nutcracker syndrome): repair by a new stenting procedure. J Vasc Surg. 1988 Oct;8(4):415-21. PMID 3172376</ref>), [[nausea]], and/or [[vomiting]], due to compression of the [[duodenum]] which also passes between the SMA and abdominal aorta). Because the left [[gonad]] drains via the left [[renal vein]], it can also result in left [[testis|testicular]] pain<ref name=hilgard_9721569/> in men or left lower quadrant pain in women.
-Unusual manifestations of the nutcracker syndrome include [[varicocele]] formation and [[varix|varices]] in the lower limbs.<ref>Little AF, Lavoipierre AM. Unusual clinical manifestations of the Nutcracker Syndrome. Australasian Radiol. 2002 Jun;46(2):197-200. PMID 12060163.</ref>
 ===Radiology Studies ===
 Nutcracker syndrome can be diagnosed with:

Nutcracker syndrome
DiseasesDB	32367