A case report of a young girl with recurrent hematuria. 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. Update on pelvic vein congestion varicose veins blog. In nutcracker syndrome, symptoms are most often caused when the left renal vein coming from the left kidney becomes compressed and blood. Mar 22, 2018 the term nutcracker phenomenon ncp refers to compression of the left renal vein lrv between the aorta and the superior mesenteric artery sma.
Anatomically, the lrv traverses the space between the superior mesenteric artery and the aorta in close proximity to the origin of the artery. The left renal vein normally helps in bringing blood out of the left kidney and sends it to the vena cava, largest vein of the body. Some people may not have symptoms, while others develop severe and persistent symptoms. It can be a common incidental finding on routine ct imaging and many patients can be. Maythurner syndrome mts, also known as the iliac vein compression syndrome, is a condition in which compression of the common venous outflow tract of the left lower extremity may cause discomfort, swelling, pain or blood clots deep venous thrombosis in the iliofemoral veins specifically, the problem is due to left common iliac vein compression by the overlying right common iliac artery. Nutcracker syndrome symptoms, treatment, causes, surgery. Mesoaortic compression of the left renal vein nutcracker. In posterior nutcracker syndrome, the left renal vein is typically compressed between the aorta and the spine. Nutcracker syndrome ncs is a syndrome caused by compression of the left renal vein lrv, between the abdominal aorta and the superior mesenteric artery, resulting in hypertension of the lrv and hematuria.
We observed a nutcracker phenomenon in a 42yearold female who underwent portal venous phase computed tomography of the body for oncologic workup. Jul 24, 2015 nutcracker syndrome is an entity resulting from left renal vein compression by the aorta and the superior mesenteric artery, which leads to symptoms of hematuria or left flank pain. To date, a variety of clinical symptoms due to mesoaortic compression of the left renal vein. Ncs, also known as renal vein entrapment syndrome or mesoaortic compression of the left renal vein lrv, results from compression of the lrv between the superior mesenteric artery sma and the aorta 20, 21. 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. The purpose of this study was to evaluate late results of lrv transposition and identify risk factors affecting outcomes. It is usually asymptomatic or may present with symptoms such as left flank pain, haematuria and hypertension, and hence it is called nutcracker. Intermittent hematuria and orthostatic proteinuria with or without abdominal or flank pain are the common clinical manifestations. In nutcracker syndrome, the renal vein coming from your left kidney becomes compressed and blood cant flow through it normally. Jan 01, 2000 the clinical syndrome caused by impingement of the left renal vein lrv between the superior mesenteric artery sma and abdominal aorta has been termed nutcracker syndrome. Interventional radiology coding case studies prepared by. Several treatment options have been described to relieve associated symptoms. 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 to the pancreas and intestines.
The renal blood accumulates in the obstructed vein and its pressure rises. The term syndrome refers to a group of signs and symptoms primarily occurring together, characteristic of a specific condition. Extravascular stent management for migration of left renal. Compression of the left renal vein between the aorta and the superior mesenteric artery has been termed the nutcracker syndrome. The presence of hematuria, proteinuria, and pain albeit atypically right sided made it nutcracker syndrome. Nutcracker syndrome refers to symptomatic compression of the left renal vein lrv by the aorta and superior mesenteric artery sma. Clinically, nutcracker syndrome is characterized by intermittent hematuria with or without left flank or abdominal pain. The underlying anatomic anomaly, first described by gant in 1937, can lead to left renal venous. Nutcracker syndrome has a range of clinical manifestations and treatment should be. Renal vein stenting for nutcracker syndrome endovascular. Furthermore, the venous return from the left gonadal vein returning to the left renal vein is blocked, thus causing testicular pain.
The superior mesenteric artery arises above this level and drapes over the left renal vein. In cases where compression is seen on imaging but there is no clinical manifestation, it is named nutcracker phenomenon. It is characterized by left renal vein entrapment between the abdominal aorta and the superior mesenteric artery causing renal venous hypertension. The increased frequency of pcs symptoms on the left side may be due to extrinsic compression of the left renal vein between the aorta and superior mesenteric artery nutcracker phenomenon. Current trends in the diagnosis and management of renal. The nutcracker syndrome is characterized by entrapment and compression of the left renal vein between the abdominal aorta and the superior mesenteric artery sma figure 1. Stents in the renal vein can cause fibromuscular hyperplasia, proximal migration or. Diagnosis and treatment of vascular compression syndromes. 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. Nutcracker syndrome wikimili, the free encyclopedia. Stents in the renal vein can cause fibromuscular hyperplasia, proximal migration. This can lead to renal venous hypertension, resulting in rupture of thinwalled veins into. 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.
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 results most commonly from the compression of the left renal vein between the abdominal aorta and superior mesenteric artery, although other variants exist. The nutcracker syndrome ncs results most commonly from the compression of the left renal vein lrv between the abdominal aorta aa and superior. Nutcracker phenomenon refers to compression of the left renal vein, most commonly between the aorta and the superior mesenteric artery, with impaired blood. Nutcracker phenomenon refers to the compression of the left renal vein between the superior mesenteric artery and abdominal aorta. Obstruction of left renal vein outflow results in venous. Left renal vein compression or nutcracker syndrome occurs when the left renal vein is squeezed or compressed by surrounding arteries of the body. Nutcracker phenomenon ncp, also known as left renal vein entrapment, is characterized by impeded outflow from the left renal vein lrv into the inferior vena cava ivc due to extrinsic lrv compression, often accompanied by demonstrable lateral hilar dilatation and medial mesoaortic narrowing schematic representation of ncp nutcracker syndrome ncs in figure 1. 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. Flow may be reduced in gastroduodenal artery and common hepatic artery. 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. Jun 22, 2017 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. Nutcracker syndrome is an entity resulting from left renal vein compression by the aorta and the superior mesenteric artery, which leads to symptoms of hematuria or left flank pain.
Unique nutcracker phenomenon involving the right renal. Nutcracker syndrome describes signs and symptoms related to renal venous hypertension secondary to aortomesenteric compression. The alternative option of endovascular or extravascular stenting is very appealing because of the minimal invasive procedures. Nutcracker syndrome got its name because the compression of the renal vein is like a nutcracker cracking a nut. Left renal venogram does reveal evidence of left renal vein compression with a faint vertical defect near the origin and significant reflux in the left gonadal vein. Maythurner syndrome mts, also known as the iliac vein compression syndrome, is a condition in which compression of the common venous outflow tract of the left lower extremity may cause discomfort, swelling, pain or blood clots deep venous thrombosis in the iliofemoral veins. It is associated with the formation of the left renal vein. The name derives from the fact that, in the sagittal plane andor transverse plane, the sma and aa with some imagination appear to be a.
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 demonstrabl. Nutcracker syndrome refers to the compression of the left renal vein between the aorta and the superior mesenteric artery, which results in. Pdf left renal vein entrapment syndrome nutcracker. Degree of left renal vein compression predicts nutcracker. The nutcracker phenomenon is usually caused by compression of the left renal vein by the superior mesenteric artery anteriorly and the aorta. Nutcracker syndrome ns refers to symptomatic compression of the left renal vein lrv between the abdominal aorta and superior mesenteric artery with potential symptoms including hematuria, proteinuria, left flank pain, and renal venous hypertension. Jul 14, 2017 it drains the left kidney across the midline via retroartic channels to the ivc the films showed left renal vein compression by the superior mesenteric artery with outflow via the ascending lumbar vein, both supra and infrarenal tributaries. Oct 04, 20 nutcracker syndrome refers to compression of the left renal vein by the superior mesenteric artery. 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.
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. In most cases, the compression is caused by a pinching of the left renal vein between the abdominal aorta and the superior mesenteric artery. Incidentally, vascular compression of the left renal vein was seen between the superior mesenteric artery and the aorta the nutcracker sign figure 1. It can cause many symptoms in both children and adults, such as flank pain and blood in the urine. We aimed to evaluate the specificity of lrv compression to ns symptoms. Left renal vein transposition for nutcracker syndrome. Obstruction of left renal vein outflow results in venous hypertension with the formation of intra and extrarenal collaterals andor the development of gonadal vein. Finally, the left renal vein can be compressed by pancreatic and other retroperitoneal neoplasms, an aberrant testicular artery, or paraaortic lymphadenopathy, all of which encroach into the aortomesenteric space. Nutcracker syndrome refers to the compression of the left renal vein between the aorta and the superior mesenteric artery, which results in elevated left renal vein pressure and possible collateral vein development. Normally, the left renal vein brings blood out of the left kidney and. This can cause renal venous hypertension high blood pressure in the kidney veins and veins to rupture.
Minimally invasive treatments for venous compression. The left renal vein stretches over the aorta to join the inferior vena cava. Nutcracker syndrome ncs refers to the clinical manifestations of ncp. 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. Left renal vein lrv compression, commonly referred to as the nutcracker syndrome or renal vein entrapment syndrome, is a rare and often overlooked condition. There is some reflux into some retroperitoneal veins and the inferior adrenal vein. It occurs when arteries, most often the abdomens aorta and superior mesenteric artery, squeeze the left renal kidney vein.
Left renal vein entrapment syndrome nutcracker syndrome. 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. The clinical syndrome caused by impingement of the left renal vein lrv between the superior mesenteric artery sma and abdominal aorta has been termed nutcracker syndrome. Obstruction of left renal vein outflow results in venous hypertension with the formation of intra and extrarenal collaterals andor the development of gonadal vein reflux. No consensus diagnostic criteria exist to guide endovascular treatment.
Instead, blood can flow backwards into other veins and cause them. Nutcracker syndrome gets its name because this compression is like a nutcracker crushing a nut. Diagnosis and treatment of vascular compression syndromes of. It is usually asymptomatic or may present with symptoms such as left flank pain, haematuria and hypertension, and hence it is called nutcracker syndrome. Retroaortic position of the left renal vein facilitates compression of the left renal vein between the aorta and the vertebral column leading to left renal venous hypertension. It drains the left kidney across the midline via retroartic channels to the ivc the films showed left renal vein compression by the superior mesenteric artery with outflow via the ascending lumbar vein, both supra and infrarenal tributaries. Meissner the nutcracker syndrome is characterized by entrapment and compression of the left renal vein between the abdominal aorta and the superior mesenteric artery sma figure 1. Nutcracker syndrome is a vascular compression disorder that refers to the compression of the left renal vein most commonly between the superior mesenteric artery sma and aorta, although other variations can exist 1. Aug 23, 20 ncs, also known as renal vein entrapment syndrome or mesoaortic compression of the left renal vein lrv, results from compression of the lrv between the superior mesenteric artery sma and the aorta 20,21.
The nutcracker syndrome ncs results most commonly from the compression of the left renal vein lrv between the abdominal aorta aa and superior mesenteric artery sma, although other variants exist. In the mixed type, theres a wide range of blood vessel changes that can cause symptoms. The nutcracker syndrome ncs is the clinical equivalent of. Compression of the subclavian vein at the thoracic outlet. Mesoaortic compression of the left renal vein definition of. Nutcracker syndrome is a vascular compression disorder that refers to the compression of the left renal vein most commonly between the superior mesenteric. Nutcracker syndrome ncs is the most common term for compression of the left renal vein between the superior mesenteric artery and the abdominal aorta. Hematuria, pelvic or back pain and left varicocele are the most commonly symptoms. Jun 12, 2016 the presence of hematuria, proteinuria, and pain albeit atypically right sided made it nutcracker syndrome. Nutcracker syndrome is a rare condition that refers to compression of left renal vein lrv between abdominal aorta and superior mesenteric artery. Some people may not have symptoms, while others develop severe and.
It is due to the compression of the distal segment of the left renal vein lrv between the superior mesenteric artery sma and the aorta also called left renal vein entrapment. Nutcracker syndrome is an easily missed cause of hematuria in children. Nutcracker syndrome ns refers to symptomatic compression of the left renal vein lrv between the abdominal aorta and superior mesenteric artery with potential symptoms including hematuria, proteinuria, left. Nutcracker syndrome servier phlebolymphologyservier. Nutcracker phenomenon and nutcracker syndrome ncbi. The nutcracker phenomenon refers to compression of the left renal vein lrv between the aorta and superior mesenteric artery sma due to an abnormally acute takeoff of the sma. Prior to consultation with me she had had an mr venogram showing compression of her left renal vein by the superior mesenteric artery nutcracker phenomena. Mesoaortic compression of the left renal vein the socalled. 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.
Nutcracker syndrome is a rare vein compression disorder. The name derives from the fact that, in the sagittal plane andor transverse plane, the sma and aa appear to be a nutcracker crushing a nut. What each clinical anatomist has to know about left renal. In nutcracker syndrome, the left renal vein is compressed between the abdominal aorta and superior mesenteric artery, acting like a nutcracker. Renal nutcracker syndrome genetic and rare diseases nih.
A rare clinical complex which occurs in relatively young and previously healthy people, which is characterised by compression of the left renal vein lrv between the aorta and superior mesenteric artery sma, fancifully likened to the effect of a nutcracker, with the aorta and sma each corresponding to an arm of the nutcracker and the lrv to the nut itself. Renal vein stenting for nutcracker syndrome endovascular today. The term nutcracker phenomenon ncp refers to compression of the left renal vein lrv between the aorta and the superior mesenteric artery sma. When nutcracker syndrome causes the compression of the left renal vein, it tends to force the blood backward that leads to its flowing into other veins, resulting in swelling. May 03, 2017 the term syndrome refers to a group of signs and symptoms primarily occurring together, characteristic of a specific condition. Aug 25, 2016 renal vein entrapment the nutcracker syndrome. Left renal vein lrv as it enters in the left kidney. Nutcracker syndrome refers to compression of the left renal vein by the superior mesenteric artery.
Blog nutcracker syndrome milford vascular institute. Renal nutcracker syndrome genetic and rare diseases. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Entrapment of the left renal vein lrv between the abdominal aorta and superior mesenteric artery sma causing the classic clinical triad of hematuria, varicocele, and left abdominal or flank pain was first described in 1950. Terms in this set 69 nutcracker syndrome is the result of extrinsic compression of what.
Nutcracker syndrome occurs when the arteries near the kidney compress the left kidney vein. The most common location of compression is between the superior mesenteric artery sma. Mesoaortic compression of the left renal vein the socalled nutcracker syndrome. A midline exposure was performed and the retroperitoneum opened as in an transabdominal aortic exposure. Nutcracker syndrome has a range of clinical manifestations and treatment should be tailored accordingly. Nutcracker phenomenon 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 vein entrapment the nutcracker syndrome brandon t. Nutcracker syndrome is caused by stenosis of the left renal vein lrv as it passes anteriorly to the aorta through the fork formed by both abdominal aorta aa and superior mesenteric artery sma. Nutcracker syndrome, caused by compression of the left renal vein lrv between the superior mesenteric artery and the aorta, results in left renal and gonadal venous hypertension.
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