Left renal vein nutcracker phenomenon

Left renal vein transposition for nutcracker syndrome. Differentiation should be made between an asymptomatic dilatation of the left renal vein nutcracker phenomenon and the nutcracker syndrome presenting. A case report of a young girl with recurrent hematuria. The nutcracker phenomenon refers to compression of the left renal vein between the aorta and superior mesenteric artery before the left renal vein joins the inferior vena cava. Nutcracker syndrome ncs is a rare entity defined by the symptomatic hypertension of the left renal vein lrv compressed in the majority of cases between the superior mesenteric artery and the aorta. Normally, the left renal vein brings blood out of the left kidney and into the inferior vena cava, the bodys largest vein.

The nutcracker phenomenon is usually caused by compression of the left renal vein by the superior mesenteric artery anteriorly and the aorta posteriorly, although variations of this anatomy have previously been reported. The nutcracker phenomenon is an entrapment of the left renal vein between the aorta and the upper intestinal artery superior mesenteric artery, which is feeding the entire small bowel in the nutcracker phenomenon, the aorta is dislodged frontally by the lumbar spine. Combined anterior and posterior nutcracker phenomenon in. This entity is better known through its anterior variant, the anterior nutcracker phenomenon, where the anterior left renal vein is compressed between the aorta and the superior mesenteric artery. Nutcracker syndrome ncs refers to the clinical manifestations of ncp. Hangge 1,2, nikhil gupta 2,3, aditya khurana 2,4, keith b. The nutcracker phenomenon ncp, also known as left renal vein entrapment refers to a situation of impeded outflow from the left renal vein lrv into the inferior vena cava ivc as a result of compression and is often accompanied by demonstrable lateral hilar dilatation and mesoaortic narrowing. Naidu 2 and rahmi oklu 2, id 1 department of general surgery, mayo clinic, phoenix, az 85054, usa. The nutcracker syndrome in a venous or even broader scope, vascular compression syndromes is based upon decreased space between the superior mesenteric artery and the aorta in the area of the left renal vein. Therefore, nutcracker phenomenon or syndrome should be defined only when the clinical symptoms are present along with compatible radiologic findings, although the terminology, nutcracker itself means the anatomical compression of the left renal vein between the. A new variant of the posterior nutcracker phenomenon. Journal of clinical medicine article degree of left renal vein compression predicts nutcracker syndrome patrick t. Its clinical features are thought to be caused by dilatation. However, nutcracker syndrome ns is characterized by coexisting of the nutcracker anatomy and characteristic symptoms.

Unique nutcracker phenomenon involving the right renal. Several treatment options have been described to relieve associated symptoms. Nutcracker syndrome an overview sciencedirect topics. Current trends in the diagnosis and management of renal. Nutcracker syndrome is an easily missed cause of hematuria in children. The left renal vein can also course posterior to the abdominal aorta retroaortic or circumaortic renal vein, allowing compression between the aorta and vertebral column, referred to as the posterior nutcracker phenomenon. In the mixed type, theres a wide range of blood vessel changes that can cause. Nutcracker syndrome ncs is a rare vascular compression disorder that involves compression of the left renal vein most commonly between the aorta and the superior mesenteric artery sma, although variations exist. In most cases, compression of the left renal vein is between the abdominal aorta the main artery in the abdomen and the superior mesenteric artery, which brings blood. Diagnosis and treatment of vascular compression syndromes.

Anatomic nutcracker features may exist without sequelae referred to as left venous renal entrapment syndrome or nutcracker phenomenon. Nutcracker syndrome ncs is the most common term for compression of the left renal vein between the superior mesenteric artery and the abdominal aorta. Degree of left renal vein compression predicts nutcracker. The term posterior nutcracker phenomenon refers to the compression of the retroaortic left renal vein between the aorta a and b, arrowhead and the vertebral column a and b, arrow. We observed a nutcracker phenomenon in a 42yearold female who underwent portal venous phase computed tomography of the body for oncologic workup. Doppler ultrasound, computed tomography ct and selective left renal vein phlebography are useful to.

Nutcracker phenomenon and nutcracker syndrome mayo clinic. Pdf left renal vein entrapment syndrome nutcracker. Clinically, nutcracker syndrome is characterized by intermittent hematuria with or without left flank or abdominal pain. The term syndrome refers to a group of signs and symptoms primarily occurring together, characteristic of a specific condition. Because the left gonadal vein drains into the left renal vein, nutcracker syndrome can cause scrotal varicocele in men. It is characterized by compression of the left renal vein lrv between the superior mesenteric artery sma and the abdominal aorta. This leads to left renal vein hypertension that may result in rupture of the thinwalled vein into the renal calyceal fornix, with the clinical presentation of. Nutcracker syndrome wikimili, the free encyclopedia. The nutcracker phenomenon, first reported more than 50 years ago, 29 is most commonly manifested by left flank and abdominal pain, usually but not implicitly accompanied by macroscopic or microscopic haematuria. Nutcracker syndromean unusual case of chronic left upper. Ncp is defined by its imaging findings, that is, entrapment of the left renal vein between the sma and the aorta, regardless of the presence of symptoms.

Renal nutcracker syndrome ncs is a condition that occurs when the left renal vein the vein that carries blood purified by the left kidney becomes compressed. N2 imaging description the nutcracker phenomenon, also known as left renal vein entrapment, refers to the compression of the left renal vein between the aorta and the superior mesenteric artery figures 96. The nutcracker syndrome or nutcracker phenomenon is, basically, the compression of the left renal vein, usually between the superior mesenteric artery and the aorta. This syndrome causes impaired blood flow, along with swelling of the distal area of the vein. Some people may not have symptoms, while others develop severe and. Nutcracker phenomenon is an uncommon condition that may lead to a syndrome of chronic abdominal pain.

It is associated with the formation of the left renal vein from the aortic collar during the 6th8th week of gestation and abnormal angulation of the sma from the aorta. Term of nutcracker syndrome ncs is used for patients with clinical symptoms associated with nutcracker anatomy. Nutcracker syndrome is a variation of nutcracker phenomenon or renal vein entrapment syndrome, in which the arteries near the kidney compress the left renal kidney vein. Left renal vein entrapment syndrome, characterized by the compression of the left renal vein lrv between the superior mesenteric artery sma and the abdominal aorta was first described in 1950. Nutcracker phenomenon is an uncommon condition characterized by compression of the left renal vein lrv between the abdominal aorta and the superior mesenteric artery sma, the sma and aorta appearing as two arms of a nutcracker compressing the lrv. It is characterized by left renal vein entrapment between the abdominal aorta and the superior mesenteric artery causing renal venous hypertension. It can be a common incidental finding on routine ct imaging and many patients. Nutcracker phenomenon, also known as left renal vein entrapment, 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. Renal nutcracker syndrome genetic and rare diseases. The development of ncs is associated with the formation of the left renal vein lrv from the aortic collar during the sixth to eighth week of gestation and abnormal angulation of the superior mesenteric artery from the aorta. In posterior nutcracker syndrome, the left renal vein is typically compressed between the aorta and the spine. Hematuria, pelvic or back pain and left varicocele are the most commonly symptoms. Left renal vein entrapment definition of left renal vein. Finally, the left renal vein can be compressed by pancreatic and other retroperitoneal neoplasms, an aberrant testicular.

The nutcracker phenomenon left renal vein lrv entrapment syndrome refers to compression of the lrv most commonly between abdominal aorta and superior mesenteric artery. An analogous compression of the retroaortic renal vein between the aorta and the vertebral column has been termed the posterior nutcracker phenomenon by other authors 4,5. Intermittent hematuria and orthostatic proteinuria with or without abdominal or flank pain are the common clinical manifestations. The nutcracker syndrome left renal vein entrapment, demonstrated by ultrasonic imaging and doppler flow scanning renal manifestations of sickle cell disease view in chinese hematuria has been attributed to the greater length of the left renal vein and the nutcracker phenomenon, in which compression of the left renal vein between. Nutcracker or left renal vein compression phenomenon. The ncs or left venous hypertension is a rare clinical manifestation often caused by the compression of left renal vein lrv between abdominal aorta and superior mesenteric artery sma, an anatomical variation known as the nutcracker phenomenon.