Nutcracker syndrome: diagnosis with Doppler US.

Kim, Seung Hyup; Cho, Seong Whi; Kim, Hong Dae; Chung, Jin Wook; Park, Jae Hyung; Han, Man Chung

doi:10.1148/radiology.198.1.8539413

Cited by 180 publications

(160 citation statements)

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“…35,84 In cases of hematuria, the number of isomorphic erythrocytes, suggesting nonglomerular origin, may be variable, and this finding is unreliable. 67,[102][103][104] Historically, a number of imaging methods have been used: renal angiography, angiographic CT, 17,21,24 digital subtraction angiography, 35 standard magnetic resonance (MR) imaging, 23 and MR angiography (Figure 2 and Figure 3). 18,23,100,105,106 Renal angiography shows delayed venous washout from the left kidney.…”

Section: Normal Anatomic and Physiologic Findingsmentioning

confidence: 99%

“…Sensitivity of DUS ranges from 69% to 90%, and specificity from 89% to 100% (summarized findings of these studies are listed in the Table). 30,44,65,103 Another study correlated DUS findings with degrees of hematuria in patients with NCP. 31 Digital subtraction angiography, DUS data, and venography pressures were compared in 93 pediatric cases to develop NCP ultrasound criteria, and 7 ultrasound grades with criteria for definite, probable, and borderline NCP were defined.…”

Section: Normal Anatomic and Physiologic Findingsmentioning

confidence: 99%

“…31 Digital subtraction angiography, DUS data, and venography pressures were compared in 93 pediatric cases to develop NCP ultrasound criteria, and 7 ultrasound grades with criteria for definite, probable, and borderline NCP were defined. 5 Kim et al 103 showed that renocaval pressure gradients did not correlate well with LRV diameter and peak velocity because of high pressure variability. However, only 4 patients with definite NCP morphologic features (LRV stenosis and dilatation) had pressure gradients of 4 mm Hg or lower (suggesting a lack of compensation through collaterals and reflux in early stages), a finding consistent with other studies.…”

Section: Normal Anatomic and Physiologic Findingsmentioning

confidence: 99%

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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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Section: Normal Anatomic and Physiologic Findingsmentioning

confidence: 99%

Section: Normal Anatomic and Physiologic Findingsmentioning

confidence: 99%

Section: Normal Anatomic and Physiologic Findingsmentioning

confidence: 99%

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Nutcracker Phenomenon and Nutcracker Syndrome

Kurklinsky¹,

Rooke

2010

Mayo Clinic Proceedings

452

586

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“…At present there is a lack of specific diagnostic tools. Measurement of the anteroposterior diameter of the LRV, together with Doppler ultrasound peak velocities may be useful in diagnosing nutcracker syndrome (2). According to many authors, a ratio higher than 5 between the Doppler ultrasound peak velocity of the narrow tract and the distended portion, is diagnostic, as well as the ratio between the diameter of the distended and the narrowed portions.…”

Section: Panel Bmentioning

confidence: 99%

Renal nutcracker syndrome

Copetti

2017

AMA

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A: The peak velocity in the LRV is 18.3 cm/sec. B; The peak velocity in the LRV in aortomesenteric portion is 110.8 cm/sec. There is evidence of "mosaic" color pattern due to the turbulent flow.A previously healthy, 31 year old woman was admitted to the emergency room with left flank pain and macrohaematuria, which began after jogging. The physical examinaTransversal scan of the abdomen. RK=Right kidney; LK=Left kidney; IVC=Inferior vena cava; AO=aorta; SMA=superior mesenteric artery, LRV=left renal vein. The arrow indicates the point of LRV compression. Panel Btion and her vital signs were normal. Ultrasonography showed that both kidneys were of normal size and echostructure, with no hydronephrosis or bladder abnormalities. The left renal vein (LRV) was enlarged (15 mm) with a winding course. Examination by Doppler ultrasound showed that blood flow was low with evidence of spontaneous echo contrast. The LRV was narrow (2 mm) between the aorta and the superior mesenteric artery (SMA) (Panel A). Color Doppler ultrasound showed a "mosaic" pattern of blood flow in the LRV, beyond the origin of the SMA. The peak velocity of systolic blood flow measured in the hilar tract and in the aortomesenteric portion of the LRV was 18.3 cm/sec and 110.8 cm/sec respectively (ratio 6.05), with a pressure gradient of 5 mmHg (Panel B). Diagnosis: Renal NutPanel A

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“…at the renal hilum and at the superior mesenteric artery crossing point, was reported by Kim et al as a successful method for the diagnosis of anterior nutcracker syndrome [8]. According to their study, a ratio of anteroposterior diameter and peak velocity greater than 5.0 show the sensitivity of 80%, specificity of 94% and diagnostic accuracy of 83% [8]. However, no criteria related to diameter and peak velocity of the left renal vein in posterior NCS are reported in the literature.…”

Section: Discussionmentioning

confidence: 94%

US and MDCT diagnosis of a rare cause of haematuria in children: Posterior nutcracker syndrome

Özel

Tufaner

Kaya

et al. 2011

Journal of Ultrasound

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KEYWORDSNutcracker syndrome; Ultrasound; Doppler; MDCT.Abstract Posterior nutcracker syndrome is caused by compression of the left renal vein between the abdominal aorta and the vertebral column. We present the case of a 14-yearold girl with vague left loin pain, mild haematuria and proteinuria. Diagnosis of this rare syndrome was achieved using color Doppler US and multidetector computed tomography (MDCT) angiography.Sommario La sindrome da schiaccianoci posteriore è dovuta alla compressione della vena renale sinistra tra l'aorta addominale e la colonna vertebrale. Viene presentato il caso di una ragazza di 14 anni con lombalgia sinistra, lieve ematuria e proteinuria, in cui la diagnosi di questa rara sindrome è stata ottenuta con Eco-color Doppler e con l'Angio-TC. ª

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Nutcracker syndrome: diagnosis with Doppler US.

Abstract: Doppler US of the LRV with measurement of the AP diameter and PV may be useful in diagnosing the nutcracker syndrome.

Cited by 180 publications

References 0 publications

Nutcracker Phenomenon and Nutcracker Syndrome

Nutcracker Phenomenon and Nutcracker Syndrome

Renal nutcracker syndrome

US and MDCT diagnosis of a rare cause of haematuria in children: Posterior nutcracker syndrome

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