Case Of Nutcracker Syndrome Research Articles

Case Report: A rare story of dysmenorrhea and hematuria in a young female with a case of nutcracker syndrome

Nutcracker syndrome (NCS) is a sporadic syndrome due to the compression of the left renal vein (LRV) between the abdominal aorta and the superior mesenteric artery (SMA). This condition may present with unexplainable pain, hematuria, orthostatic hypotension, proteinuria, or dysfunction of the kidneys. These symptoms would be explained by the fact that if a chronically standing venous congestion is there then there could be the development of gonadal vein and pelvic vein collateral drainage pathways. Doppler USG (ultrasound), cross-sectional and invasive imaging modalities are frequently used for the purpose of diagnosis. Here, in this report, there's a female patient in her mid- 20's. She was asymptomatic since birth and presented with a history of abdominal pain and blood in the urine. USG is not the best modality for describing the findings hence a further contrast-enhanced computed tomography was done which reported an NCS. In all cases of unexplained hematuria, after excluding all differential diagnoses, NCS must be taken into account.

Nutcracker Syndrome combined with Superior Mesenteric Artery Syndrome in a Pediatric Patient: A Case Report

Nutcracker syndrome is a phenomenon that the left renal vein (LRV) is pressed between the superior mesenteric artery (SMA) and the aorta. Clinical characteristics include gross or microscopic hematuria, orthostatic proteinuria, abdominal pain, and back pain. It occurs due to LRV squeezing caused by narrowed aortomesenteric angle. SMA syndrome is a disease that the third part of the duodenum is prone to intestinal obstruction by narrowed angle between the SMA and the abdominal aorta. Clinical symptoms include postprandial abdominal distension, epigastric pain, nausea, and vomiting. SMA syndrome and nutcracker syndrome have common features that result from narrowed aortomesenteric angle. However, it is very rare for both syndromes to occur simultaneously, so the two syndromes are regarded as separate diseases. This is a report on a case of nutcracker syndrome with SMA syndrome in a child who presented gross hematuria, recurrent abdominal pain and vomiting. To our knowledge, nutcracker syndrome simultaneous with SMA syndrome has not been previously reported in pediatric patient, especially with an exhibition of gross hematuria. This case suggests that the simultaneous presence of SMA syndrome with the same pathogenesis needs to be considered when nutcracker syndrome is suspected in pediatric patients with hematuria. Key words: Nutcracker syndrome; Superior mesenteric artery syndrome; Aortomesenteric angle

A Case of Nutcracker Syndrome in an Adult Treated by Stenting: Ultrasonography Findings

A Case of Nutcracker Syndrome in an Adult Treated by Stenting: Ultrasonography Findings

Laparoscopic inferior mesenteric-gonadal vein bypass for the treatment of nutcracker syndrome

Nutcracker syndrome is a rare entity caused by extrinsic compression on the left renal vein (LRV) crossing between the superior mesenteric artery and the aorta. This article reports the treatment of two cases of nutcracker syndrome using laparoscopic inferior mesenteric-gonadal vein bypass, knowing that this treatment option would avoid renal reperfusion injury and LRV hypertension. In addition, it is easier to operate compared with laparoscopic splenorenal venous bypass and laparoscopic transposition of LRV into the inferior vena cava.

Two cases of nutcracker syndrome

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Nutcracker Syndrome Diagnosed with 3-Dimensional Computed Tomography Angiography

We report a case of nutcracker syndrome diagnosed with 3-dimensional computed tomography angiography (3-D CTA). Nutcracker syndrome had been confirmed by conventional venography until recent years. Nowadays, with the development of imaging techniques, color Doppler sonogram and 3-D CTA are replacing venography for the diagnosis of nutcracker syndrome. The patient, a 20-year-old male, had abrupt gross hematuria and left abdominal pain 6 months previously and intermittent microscopic hematuria thereafter. Including renal biopsy, the results of conventional hematuria study showed no abnormalities. 3-D CTA showed left renal vein compression between the abdominal aorta and superior mesenteric artery and collateral veins. The angle and distance between the superior mesenteric artery and aorta at the level of the left renal vein were 35 o and 3.0 mm, respectively. We diagnosed nutcracker syndrome and later confirmed the diagnosis with venography. (Korean J Urol 2009;50:711-713)

Compression of left inferior vena cava: A form of nutcracker syndrome

Left renal vein hypertension has been described in the literature as a cause of persistent hematuria. We report a case of nutcracker syndrome with hematuria involving the left inferior vena cava diagnosed with Doppler sonography and MRI.

Macroscopic Haematuria in a 15-year old Male: A Case of Nutcracker Syndrome Managed by Endovascular Stenting

Macroscopic Haematuria in a 15-year old Male: A Case of Nutcracker Syndrome Managed by Endovascular Stenting

Unexpected superimposition of nutcracker effect in various conditions: is it an unrecognized confounding factor?

Sir, We read with great interest the recent contribution by Harada et al. in Eur J Pediatr [1]. They reported a 5-year old girl with Henoch–Schonlein purpura (HSP) presenting duodenal involvement which might be associated with superior mesenteric artery syndrome (SMAS). She showed compression of the third segment of the duodenum by a short aortomesenteric distance and a narrow angle between the aorta and the superior mesenteric artery (nutcracker effect). Nutcracker effect can cause SMAS or left renal vein entrapment syndrome (nutcracker syndrome), because the third portion of the duodenum and left renal vein normally traverse between the two arteries. We also reported previously an HSP child with hematuria, which was associated with nutcracker syndrome rather than the vasculitic involvement of the kidney [4]. We would never have diagnosed this syndrome if we had not used renal Doppler ultrasound, because anyone who sees an HSP patient with hematuria generally regards that patient as having HSP nephritis. Recently, we have also experienced additional cases of nutcracker syndrome superimposed on HSP or post-streptococcal glomerulonephritis (PSGN). Patient 1 A 13-year-old girl was shown to have HSP nephritis on renal biopsy and was treated with prednisolone, leading to resolution of proteinuria. However, intermittent and exercise-induced hematuria persisted. Renal Doppler ultrasound had also demonstrated the superimposition of nutcracker syndrome (peak velocity ratio 7.4, normal <4.0). Although HSP nephritis was mainly responsible for the hematuria and proteinuria in this case, nutcracker syndrome might also have aggravated them. Patient 2 A 6-year-old boy presented with gross hematuria, which was coke-like, but sometimes pinkish. He was normotensive and had no acute nephritic features. Laboratory findings showed that antistreptococcal O (ASO) titer was increased (570 todd units, normal <200 todd units) and C3 was decreased (43 mg/dl, normal 77–195 mg/dl). ASO titer was much increased 4 weeks later (811 todd units) but gradually decreased 7 weeks later (398 todd units). C3 level had normalized 4 weeks later (107 mg/dl). Therefore, the diagnosis of PSGN was made. However, we also performed a renal Doppler ultrasound in this case, because the color of gross hematuria was sometimes pinkish, which demonstrated the superimposition of nutcracker syndrome (peak velocity ratio 6.9). Gross hematuria disappeared 1 month later, but microscopic hematuria persisted for more than 2 years. We performed a follow-up renal Doppler ultrasound at 14 months, which showed persistent elevation of the peak velocity ratio (peak velocity ratio Eur J Pediatr (2007) 166:1089–1090 DOI 10.1007/s00431-006-0382-y