From Nutcracker Phenomenon to Nutcracker Syndrome: A Pictorial Review.

Antonio Granata,Pietro Valerio Foti,Michele Figuera,Giulio Distefano,Stefano Palmucci,Antonio Basile,Alessio Sturiale

doi:10.3390/diagnostics11010101

Antonio Granata, Pietro Valerio Foti + Show 5 more

Open Access

https://doi.org/10.3390/diagnostics11010101

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Journal: Diagnostics	Publication Date: Jan 11, 2021
Citations: 32	License type: CC BY 4.0

Affiliation: Ospedale Cannizzaro, University of Catania

Abstract

Left renal vein (LRV) entrapment, also known as nutcracker phenomenon if it is asymptomatic, is characterized by abnormality of outflow from the LRV into the inferior vena cava (IVC) due to extrinsic LRV compression, often accompanied by demonstrable lateral (hilar) dilatation and medial (mesoaortic) stenosis. Nutcracker syndrome, on the other hand, includes a well-defined set of symptoms, and the severity of these clinical manifestations is related to the severity of anatomic and hemodynamic findings. With the aim of providing practical guidance for nephrologists and radiologists, we performed a review of the literature through the PubMed database, and we commented on the definition, the main clinical features, and imaging pattern of this syndrome; we also researched the main therapeutic approaches validated in the literature. Finally, from the electronic database of our institute, we have selected some characteristic cases and we have commented on the imaging pattern of this disease.

Highlights

Any vessel can be compressed by adjacent anatomic structures, or they may cause compression of adjacent hollow viscera
We used the following keywords: “nutcracker syndrome”, “nutcracker phenomenon”, “Left renal vein (LRV) entrapment”, and “LRV compression”, and we examined titles and abstracts
Nutcracker syndrome, on the other hand, is the term used to define the LRV entrapment associated with a well-defined set of symptoms, and the severity of these clinical manifestations is related to the severity of anatomic and hemodynamic findings [4,5,6]

Summary

Background

Any vessel can be compressed by adjacent anatomic structures (bone, organs, and other vessels), or they may cause compression of adjacent hollow viscera. The aim of this work is to provide a critical review of the acquisitions in the international literature relating to LRV compression syndrome, defining relevant imaging patterns for diagnostic purposes, providing the clinician with an address on when and how to use the terms nutcracker syndrome (NS) or nutcracker phenomenon (NP), and what to expect from imaging. For this purpose, in October 2020, we performed a search through the PubMed databases in the fields of abdominal vessel imaging and abdominal vascular entrapment syndromes.

Definition

Epidemiology

Pathogenesis and Mechanism of LRV Entrapment

Conclusions