Learning objectives
To Know the Nutcracker Syndrome and consider it within the differential diagnosis in young patients presenting with hematuria, proteinuria, left flank pain, left varicocele or pelvic congestion syndrome.
Background
Nutcracker syndrome (NCS) is usually caused by a functional stenosis of the left renal vein (LRV) due to its compression between the superior mesenteric artery (SMA) and the aorta, which constitutes the anterior Nutcracker Syndrome.
Less frequently, the LRV is arranged in a retro aortic situation and is compressed between the aorta and the vertebral body, which constitutes the posterior Nutcracker syndrome.
It is more frequent in young patients, in the 3rd-4th decade of their lives, previously healthy, with a higher incidence in women. In...
Findings and procedure details
We reviewed the abdomen CT of patients diagnosed with NCS in our hospital during the last year, with different clinical manifestations, that illustrate the spectrum of this syndrome.
DIAGNOSIS
The first step in the diagnosis is a good examination and medical history.
Doppler Ultrasound is the initial diagnostic imaging technique with a sensitivity of 78% and a specificity of 100%. It allows assessing the decrease in the anteroposterior diameter of the LRV and measuring the maximum flow rate before and after passing through the fork...
Conclusion
CONCLUSION
Nutcracker syndrome is a diagnosis of exclusion.
To avoid diagnostic delays, consider young patients with hematuria, left flank pain, varicocele, or pelvic congestion syndrome not justified by other causes.
Color Doppler ultrasound and MDTC or Magnetic resonance angiography are very useful in the diagnosis confirmed by phlebography and the measurement of a gradient of reno-cava pressure >3mmHg.
Personal information and conflict of interest
M. T. Garzon Guiteria:
Nothing to disclose
P. Arias Rodriguez:
Nothing to disclose
S. De La Mano Gonzalez:
Nothing to disclose
P. Garzón:
Nothing to disclose
J. M. Garrido:
Nothing to disclose
B. Prieto García:
Nothing to disclose
References
1. Ahmed K, Sampath R, Khan M, Current Trends in the diagnosis and Management of Rena Nutcracker Syndrome: A review. Eur J Vasc Endovasc Surg.2006; 31,410-416
2. Martinez-Salamanca JI, Herranz F, Gordillo I, Diez JM, Subirá D,Castaño I, Moralejo M. Síndrome Nutcracker o Cascanueces: Demostración mediante TC helicoidal con reconsrucción 3D (VR) Actas Urol Esp. Julio -Agosto 2004;28 (7) 549-552
3. El Harrech Y,Jira H et al. Actitud expectante en el síndrome del cascanueces
4. Kyung et col. Diagnostic value of computed tomographic findings of...