Prevalence of left renal vein compression (nutcracker phenomenon) signs on computed tomography angiography of healthy individuals

Ribeiro, Felipe Soares; Puech-Leão, Pedro; Zerati, Antônio Eduardo; Nahas, William C.; David‐Neto, Elias; Luccia, Nélson De

doi:10.1016/j.jvsv.2020.04.005

Cited by 23 publications

(12 citation statements)

References 25 publications

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“…Doppler ultrasound (US), in expert hands, can be the first imaging exam which allows recognizing CA stenosis in MALS and LRV stenosis in NCS. Computed tomography (CT) angiography may provide further details for diagnosis, such as the “hook sign” of CA typical for MALS or “beak sign” of the LVR typical for NCS [11 , 12] .…”

Section: Introductionmentioning

confidence: 99%

A man with the rare simultaneous combination of three abdominal vascular compression syndromes: median arcuate ligament syndrome, superior mesenteric artery syndrome, and nutcracker syndrome

Farina¹,

Gozzo²,

Foti³

et al. 2021

Radiology Case Reports

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Median arcuate ligament syndrome and superior mesenteric artery syndrome are well-known abdominal compression syndromes, the coexistence of which is rarely described in literature. In addition, due to the common pathogenesis, anterior nutcracker syndrome may occur simultaneously to superior mesenteric artery syndrome. To our knowledge, this is the first case reporting combination of these 3 syndromes detected with ultrasound, Computed Tomography and upper gastrointestinal fluoroscopic exam. A 69-year-old man came to our attention for rapid weight loss, postprandial epigastric pain and recurrent vomiting for at least 6 months. Doppler ultrasound showed both celiac artery and left renal vein stenosis with simultaneous left varicocele. Computed tomography showed a reduction of aortomesenteric space causing both left renal vein and duodenal stenosis, this latter confirmed by upper gastrointestinal fluoroscopic exam. The diagnosis of these three vascular compression syndromes (MALS, SMAS, and anterior NCS) has been formulated, based on clinical and imaging findings. We assumed that the postprandial crises caused by median arcuate ligament syndrome may induce a reduction of meals consumption and progressive weight loss which can be a cause of anterior nutcracker syndrome and superior mesenteric artery syndrome onset. Doppler ultrasound, in expert hands, allows to accurately diagnosing these syndromes which are often underestimated. Failure to recognize it and inadequate treatment could have serious consequences for patients' health.

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Section: Introductionmentioning

confidence: 99%

A man with the rare simultaneous combination of three abdominal vascular compression syndromes: median arcuate ligament syndrome, superior mesenteric artery syndrome, and nutcracker syndrome

Farina¹,

Gozzo²,

Foti³

et al. 2021

Radiology Case Reports

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show abstract

“…NCS diagnosis is confirmed mainly by image evaluation, but no unified diagnostic standard exists [ 1 , 2 , 11 ]. CT and Doppler ultrasonography are the imaging methods most commonly used for diagnosis; the diagnostic criteria are the distance between the SMA and abdominal aorta and the beak sign in axial images, and the angle between SMA and abdominal aorta in sagittal images [ 1 , 4 , 11 , 12 ]. Another method of diagnosis is to measure the blood pressure gap between the IVC and LRV, but this method is invasive and uncommon [ 1 , 2 , 4 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…The prevalence of the nutcracker phenomenon ranges from 4.1% to 7.8% among healthy individuals, and of these cases, 8.8% or fewer are symptomatic NCS [ 2 , 11 ]. Younger age, low BMI, and female sex are risk factors for this illness [ 1 , 11 ]. Our patient, however, was elderly and had a BMI of 27.4.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous rupture of the ovarian vein in association with nutcracker syndrome: a case report

2021

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Background Nutcracker syndrome is a condition in which the left renal vein is pinched between the abdominal aorta and the superior mesenteric artery, resulting in an increase in renal vein pressure and certain symptoms. We report a very rare case of retroperitoneal hematoma caused by the rupture of varicose veins of the left ovary. Case presentation A 77-year-old Japanese woman, para 7, experienced sudden left lower abdominal pain. She had no history of trauma or treatment complications. Computed tomography revealed a left retroperitoneal hematoma, but her abdominal pain subsided quickly; thus, urgent treatment was not required. We then scheduled her for an assessment regarding the cause of her bleeding. However, 6 days after the pain onset, abdominal pain symptoms recurred, confirming hematoma regrowth. Magnetic resonance imaging and three-dimensional computed tomography revealed an abnormal vascular network from the left side of the uterus to the left adnexa. Subsequent angiography revealed that the retroperitoneal bleeding originated from rupture of the distended left ovarian vein, which caused blood reflux from the left renal vein to the left ovarian vein. Although angiography confirmed a passage between the left renal vein and inferior vena cava, computed tomography showed obvious stenosis in the left renal vein. In accordance with these findings, we diagnosed the cause of the distention and rupture of the left ovarian vein as nutcracker syndrome. She underwent embolization of the left ovarian vein as hemostasis treatment, and had a good course thereafter. Conclusions This is the first report of a spontaneous rupture of the left ovarian vein caused by nutcracker syndrome. Nutcracker syndrome is not yet well known to clinicians and should be considered as part of the differential diagnosis when an abnormal vascular network in the pelvis is found.

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“…According to Ribeiro et al, a Nutcracker syndrome refers to the cascade of symptoms developing due to increased venous pressure in the left renal vein due to obstruction of its venous outflow into the inferior vena cava. 31 This finally results in the development of intra-and extra-renal hypertensive valveless venous collateral vessels.…”

Section: Renal Veinsmentioning

confidence: 99%

Evaluation of renal vasculature and its variants by CT angiography

et al. 2022

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Background: Kidneys are a pair of retroperitoneal organs supplied by a single renal artery and vein. However, the classic illustration of the renal vasculature, formed by one renal artery and one renal vein, occurs in ≤25% of cases. MDCT angiography is presently the most preferred investigation for assessing prospective renal donors. Aims and Objectives: This study aims to familiarize urologists with the variations found in the renal vascular system, emphasizing prevalence, the adequate, appropriate terms, and the clinical and surgical implications involved. Materials and Methods: A cross-sectional study in 50 patients clinically indicated to undergo CT Renal angiographic study over 2 years is included in the study. This study was carried out to look for any anatomical variants in renal vasculature. CT examination was performed on a multidetector 16 slice CT Siemens scanner in the department of radiodiagnosis. Once conventional CT is done, the data obtained can produce 3D post-processing images that simulate conventional angiograms. Results: Out of 50 patients, single renal arteries are present in 27, and multiple renal arteries are present in 23 patients. Out of 27 patients with single renal arteries, 22.2 % has perihilar arterial branching. The most common variant was accessory renal arteries, which are found in 56% of individuals, followed by aberrant renal arteries found in 30% of individuals. Double renal arteries are found in 8.7% and triple renal arteries in 4.3% of cases. Out of 50 patients, 48 patients have a single renal vein, whereas two patients have supernumerary veins. The present study found right renal vein duplication in only 2% of patients. Conclusion: Renal arteries and veins show numerous variations in their origin sites, numbers, course, and division patterns. These variants exist in the population with high prevalence and are thus crucial in preoperative and intra-operative analysis for better prognosis and reduced complications. Preoperative CT evaluation of renal vasculature using MDCT angiography helps depict the presence or absence of renal arterial and venous variants.

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Prevalence of left renal vein compression (nutcracker phenomenon) signs on computed tomography angiography of healthy individuals

Cited by 23 publications

References 25 publications

A man with the rare simultaneous combination of three abdominal vascular compression syndromes: median arcuate ligament syndrome, superior mesenteric artery syndrome, and nutcracker syndrome

A man with the rare simultaneous combination of three abdominal vascular compression syndromes: median arcuate ligament syndrome, superior mesenteric artery syndrome, and nutcracker syndrome

Spontaneous rupture of the ovarian vein in association with nutcracker syndrome: a case report

Evaluation of renal vasculature and its variants by CT angiography

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