Anatomic and hemodynamic evaluation of renal venous flow in varicocele formation using color Doppler sonography with emphasis on renal vein entrapment syndrome

Ünlü, M. S.; Örgüç, Şebnem; Serter, Selim; Pekindil, Gökhan; Pabuşçu, Yüksel

doi:10.1080/00365590600796659

Cited by 21 publications

(13 citation statements)

References 16 publications

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“…In agreement with Zerhouni et al and Unlu et al, in the current study, the left renal vein nutcracker phenomenon was detected in the majority of cases (82%) being of the anterior type (pre-aortic) in (76%) of cases and being posterior type (retro-aortic) in (6%) of cases (Table 3); this eventually considered the left renal vein entrapment as the primary cause of left gonadal vein reflux [10,11]. For nutcracker phenomenon diagnosis, the aorto-mesenteric window (distance), the aortomesenteric angle, the velocity ratio in the left renal vein segments were measured as well as the diameter of the left renal vein in the aorto-mesenteric space and compared with the preceding (hilar) dilated segment [1,12].…”

Section: Discussionsupporting

confidence: 92%

Role of trans-abdominal and trans-perineal venous duplex ultrasound in cases of pelvic congestion syndrome

Baz

2019

Egypt J Radiol Nucl Med

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Background: For evaluation the role of trans-abdominal and trans-perineal venous duplex ultrasound in cases of pelvic congestion syndrome, fifty patients with pelvic congestion syndrome were included in the current research. All were evaluated by trans-abdominal and trans-perineal venous duplex. Results: An incompetent left gonadal vein was detected in all cases with a mean diameter (± SD) = 7.9 ± 1.1 mm. The right gonadal vein was incompetent in 4 cases (8%) with a mean diameter (± SD) 5.9 ± 0.4 mm. A refluxing proximal internal iliac vein was detected in 3cases (6%). Left renal vein nutcracker was present in 41cases (82%) while the left common iliac vein compression was present in 3 cases (6%). Vulvoperineal varicosities were seen in all cases {right side = (36%, n = 18), left side = (30%, n = 15), and bilateral = (34%, n = 17)}.Thigh extension of the vulvoperineal varicosities was present in (74%, n = 37). Round ligament varicosities were present in (6%, n = 3). Conclusions: Trans-abdominal and trans-perineal venous duplex offer a simple, noninvasive, and quick technique that can help in an accurate evaluation of the ovarian vein reflux, diameters as well as the presence of vulvoperineal, and round ligament varicosities, Moreover, it is useful in the assessment of the left renal and iliac veins compression.

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Section: Discussionsupporting

confidence: 92%

Role of trans-abdominal and trans-perineal venous duplex ultrasound in cases of pelvic congestion syndrome

Baz

2019

Egypt J Radiol Nucl Med

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“…Considering the frequency of incompetency or absence of spermatic vein valves, Zerhouni et al 25 contend that this finding is irrelevant and that LRV hypertension is the usual cause of varicoceles. The LRV was compressed in 50% to 100% of all patients with varicocele, 8,60 although not all patients with varicocele have a distended LRV. 10,37 Venous varicosities may be seen internally around the renal pelvis, upper ureter, 22 and calyx 20,57 and sometimes externally at the buttocks or in the vulvar area.…”

Section: Clinical Featuresmentioning

confidence: 99%

Nutcracker Phenomenon and Nutcracker Syndrome

Kurklinsky¹,

Rooke

2010

Mayo Clinic Proceedings

452

586

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N utcracker phenomenon (NCP), also known as left renal vein entrapment,1-3 is characterized by impeded outflow from the left renal vein (LRV) into the inferior vena cava (IVC) due to extrinsic LRV compression, often accompanied by demonstrable lateral (hilar) dilatation and medial (mesoaortic) narrowing (schematic representation of NCP/ nutcracker syndrome [NCS] in Figure 1). Although the terms nutcracker syndrome and nutcracker phenomenon are sometimes used interchangeably in the literature, Shin and Lee 4 emphasize that the nutcracker anatomy is not always associated with clinical symptoms and that some of the anatomic findings suggestive of nutcracker may represent a normal variant or be accounted for by other conditions. Therefore, the term nutcracker syndrome should be reserved for patients with characteristic clinical symptoms associated with demonstrable nutcracker morphologic features. No consensus exists on what symptoms are severe enough to warrant the designation of a clinical syndrome or to what extent various findings may simply reflect different evolutionary stages of the process. Because of these uncertainties, some authors focus on the characteristic anatomic and hemodynamic findings, referring to them as NCP rather than NCS. 5Nutcracker phenomenon refers to compression of the left renal vein, most commonly between the aorta and the superior mesenteric artery, with impaired blood outflow often accompanied by distention of the distal portion of the vein. The nutcracker syndrome (NCS) is the clinical equivalent of nutcracker phenomenon characterized by a complex of symptoms with substantial variations. Depending on specific manifestations, NCS may be encountered by different medical specialists. Although it may be associated with substantial morbidity, the diagnosis of NCS is often difficult and is commonly delayed. Diagnostic and treatment criteria are not well established, and the natural history of NCS is not well understood. We performed an initial review of the literature through MEDLINE, searching from 1950 to date and using the keywords nutcracker syndrome, nutcracker phenomenon, and renal vein entrapment. We performed additional reviews based on the literature citations of the identified articles. We attempted to elucidate clinical relevance of these conditions and their prominent features and to summarize professional experience. Mayo Clin

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“…Preand post-compression velocity ratios can also be utilised. The ratio of the inner diameter of the LRV at the hilum to the diameter at the compression point has also been utilised [28]. A ratio of more than three in the supine position, and a ratio of more than five in the standing position (for more than 15 min) are considered abnormal [29].…”

Section: Imaging Findingsmentioning

confidence: 99%

Venous compression syndromes: clinical features, imaging findings and management

Butros¹,

Liu²,

Oliveira³

et al. 2013

BJR

136

206

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Extrinsic venous compression is caused by compression of the veins in tight anatomic spaces by adjacent structures, and is seen in a number of locations. Venous compression syndromes, including Paget-Schroetter syndrome, Nutcracker syndrome, May-Thurner syndrome and popliteal venous compression will be discussed. These syndromes are usually seen in young, otherwise healthy individuals, and can lead to significant overall morbidity. Aside from clinical findings and physical examination, diagnosis can be made with ultrasound, CT, or MR conventional venography. Symptoms and haemodynamic significance of the compression determine the ideal treatment method.

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Anatomic and hemodynamic evaluation of renal venous flow in varicocele formation using color Doppler sonography with emphasis on renal vein entrapment syndrome

Cited by 21 publications

References 16 publications

Role of trans-abdominal and trans-perineal venous duplex ultrasound in cases of pelvic congestion syndrome

Role of trans-abdominal and trans-perineal venous duplex ultrasound in cases of pelvic congestion syndrome

Nutcracker Phenomenon and Nutcracker Syndrome

Venous compression syndromes: clinical features, imaging findings and management

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