To describe clinical and radiological findings and therapeutic strategies of nutcracker syndrome through some cases taken from our archive,
differentiating it from nutcracker phenomenon.
The nutcracker phenomenon is defined as an anatomical condition characterized by extrinsic vascular compression of left renal vein (LRV) with consequent obstacle to venous outflow in the inferior vena cava (IVC).
Despite the terms nutcracker syndrome and nutcracker phenomenon are often used interchangeably,
it must be emphasized that left renal vein compression is not always associated with symptoms.
Definition of “nutcracker syndrome” (NCS) is the association of typical symptoms with morphological characteristics; instead,
the term "nutcracker phenomenon" should be used in absence of symptoms.
Findings and procedure details
Nutcracker syndrome and/or nutcracker phenomenon have a pathophysiology that depends on aetiological factors.
They determine compression of LRV with increased ipsilateral renal venous pressure and,
break of thin-wall varices in the collector system.
In an early phase,
collateral veins are developed and increase venous capacity; in this phase the continence of ovarian and lumbar vein valves is maintained.
This anatomic situation results in clinical manifestations: flank pain,
micro/macrohaematuria (occasionally with anemia requiring blood transfusions).
Abdominal pain in left side and in pelvis may...
NCS is a condition whose symptoms vary depending on the stage and whose characteristics are not specific,
overlapping with many other clinical entities.
pelvic pain and varicocele should give the suspicion of this syndrome to interventional radiologist and surgeon for a correct diagnostic-therapeutic management.
Surgical or interventional treatment,
performed only in symptomatic cases,
can be single or combined and must be carefully chosen also based on the type of nutcracker syndrome and its anatomical-clinical characteristics.
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Nutcracker Phenomenon and Nutcracker Syndrome review.
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