Nutcracker Syndrome—How Well Do We Know It?

He, Yangyan; Wu, Ziheng; Chen, Shanwen; Tian, Lu; Li, Donglin; Li, Ming; Jin, Wei�; Zhang, Hongkun

doi:10.1016/j.urology.2013.08.033

Cited by 117 publications

(166 citation statements)

References 36 publications

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“…Other uncommon causes such as pancreatic neoplasm, paraaortic lymphadenopathy, retroperitoneal tumor, abdominal aortic aneurysm, overarching testicular artery, LRV duplication, and ectopic ventral right renal artery and strangulating fibrolymphatic tissue may play a role on the etiology of posterior NCS. Left renal ptosis, lordosis and decreased retroperitoneal and mesenteric fat tissue may cause to NCS [1][2][3] . Right-sided NCS is a more rare condition.…”

Section: Anatomical Configuration and Pathophysiologymentioning

confidence: 99%

“…Right-sided NCS is a more rare condition. Pregnancy is defining as a factor contributing to right-sided NCS by compression of large veins [1] . Left-sided IVC, hemiazygos continuation and persistent left superior vena cava combination is another rare cause of right NCS [4] .…”

Section: Anatomical Configuration and Pathophysiologymentioning

confidence: 99%

“…Pain is a result of the inflammatory cascade triggered by venous hypertension. Flank pain and abdominal pain are the consequences of that inflammatory process [1] . Left flank pain can be due also to urethral colic related to blood clots passing down to left ureter [7] .…”

Section: Clinical Featuresmentioning

confidence: 99%

“…Seventy-five percent of patients with hematuria have complete resolution during this time [7] . Angiotensin inhibitors could be effective in patients with especially severe and prolonged orthostatic proteinuria [1] . Surgical procedures are used for treatment in patients with severe symptoms.…”

Section: Treatmentmentioning

confidence: 99%

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Nutcracker syndrome

Gulleroglu

Gülleroğlu

Baskın

2014

WJN

130

163

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The nutcracker phenomenon [left renal vein (LRV) entrapment syndrome] refers to compression of the LRV most commonly between abdominal aorta and superior mesenteric artery. Term of nutcracker syndrome (NCS) is used for patients with clinical symptoms associated with nutcracker anatomy. LRV entrapment divided into 2 types: anterior and posterior. Posterior and right-sided NCSs are rare conditions. The symptoms vary from asymptomatic hematuria to severe pelvic congestion. Symptoms include hematuria, orthostatic proteinuria, flank pain, abdominal pain, varicocele, dyspareunia, dysmenorrhea, fatigue and orthostatic intolerance. Existence of the clinical features constitutes a basis for the diagnosis. Several imaging methods such as Doppler ultrasonography, computed tomography angiography, magnetic resonance angiography and retrograde venography are used to diagnose NCS. The management of NCS depends upon the clinical presentation and the severity of the LRV hypertension. The treatment options are ranged from surveillance to nephrectomy. Treatment decision should be based on the severity of symptoms and their expected reversibility with regard to patient's age and the stage of the syndrome.

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Section: Anatomical Configuration and Pathophysiologymentioning

confidence: 99%

Section: Anatomical Configuration and Pathophysiologymentioning

confidence: 99%

Section: Clinical Featuresmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

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Nutcracker syndrome

Gulleroglu

Gülleroğlu

Baskın

2014

WJN

130

163

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“…Posterior NCS is the compression of LRV by abdominal aorta and vertebral column. Some acquired causes may play a role on the etiology of posterior NCS such as LRV duplication, paraaortic lymphadenopathy, retroperitoneal mass, aneurysm of abdominal aortic, overarching testicular artery and ventral replacement of right renal artery (6,7). However, all of the anatomic mechanisms lead to renal vein contraction resulting in outflow blockage with a measurable renocaval pressure gradient.…”

Section: Discussionmentioning

confidence: 99%

The Nutcracker Syndrome as a Rare Cause of Chronic Abdominal Pain: A Case Report

Pournasiri

2016

J Compr Ped

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Introduction: Renal vein entrapment, named nutcracker phenomenon, is a contraction of renal vein between abdominal aorta and superior mesenteric artery. Patients can be asymptomatic or clinically manifested, called nutcracker syndrome. Proteinuria, hematuria, flank pain, varicocele in males and pelvic congestion in females are reported in such patients. Case Presentation: The current report presented an eight-year-old girl with microscopic hematuria and chronic abdominal pain along with short review of anatomy, pathophysiology, clinical significance and management of this syndrome. Conclusions:The nutcracker syndrome should be differentiated from unexplained chronic abdominal pain.

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