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{{SK}} nutcracker phenomenon; renal vein entrapment syndrome; mesoaortic compression of the left renal vein | |||
==Overview== | |||
The nutcracker syndrome is a compression of the left [[renal vein]] between the [[abdominal aorta]] (AA) and [[superior mesenteric artery]] (SMA).<ref>Sugimoto I, Takashi O, Ishibashi H, Takeuchi N, Nagata Y, Honda Y. Left Renal Vein Entrapment Syndrome (Nutcracker Syndrome) treated with Left Renal Vein Transposition. Jnp J Vasc Surg. 2001 10:503-507. [http://www.jsvs.org/en/journal/abstract.php?bn=20011004&no=8 Abstract].</ref> | |||
== | ==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. | 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. | 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. | ||
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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> | 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 can be diagnosed with: | ||
* Left renal [[venography]] — considered to be the [[gold standard (test)|gold standard test]]. | * Left renal [[venography]] — considered to be the [[gold standard (test)|gold standard test]]. | ||
* [[Computed tomography]] (CT). | * [[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 (fruit)|nut]] (the [[renal vein]]). | ||
* Abdominal [[ultrasonography]] — not definitive but has been found to be useful.<ref>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.</ref> | * Abdominal [[ultrasonography]] — not definitive but has been found to be useful.<ref>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.</ref> | ||
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== References == | == References == | ||
{{Reflist|2}} | |||
== External links == | == External links == | ||
Revision as of 02:00, 10 September 2012
| Nutcracker syndrome | |
| DiseasesDB | 32367 |
|---|---|
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
The nutcracker syndrome is a compression of the left renal vein between the abdominal aorta (AA) and superior mesenteric artery (SMA).[1]
Diagnosis
Symptoms
The syndrome is associated with hematuria, which can lead to anemia[2], abdominal complaints or pain[3] (classically left flank pain[4]), 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 testicular pain[3] in men or left lower quadrant pain in women.
Unusual manifestations of the nutcracker syndrome include varicocele formation and varices in the lower limbs.[5]
=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.[6]
Treatment
Treatment depends on the severity and symptoms. Treatments include:
- Endovascular stenting.[4]
- Renal vein re-implantation.[7]
- Gonadal vein embolization.[7]
References
- ↑ Sugimoto I, Takashi O, Ishibashi H, Takeuchi N, Nagata Y, Honda Y. Left Renal Vein Entrapment Syndrome (Nutcracker Syndrome) treated with Left Renal Vein Transposition. Jnp J Vasc Surg. 2001 10:503-507. Abstract.
- ↑ 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.
- ↑ 3.0 3.1 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.
- ↑ 4.0 4.1 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
- ↑ Little AF, Lavoipierre AM. Unusual clinical manifestations of the Nutcracker Syndrome. Australasian Radiol. 2002 Jun;46(2):197-200. PMID 12060163.
- ↑ 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.
- ↑ 7.0 7.1 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.