Open AccessNutcracker syndrome
Author(s) -
Kaan Gülleroğlu,
Başak Gülleroğlu,
Esra Baskın
Publication year - 2014
Publication title -
world journal of nephrology
Language(s) - Uncategorized
Resource type - Journals
ISSN - 2220-6124
DOI - 10.5527/wjn.v3.i4.277
Subject(s) - medicine , nutcracker syndrome , radiology , asymptomatic , orthostatic vital signs , abdominal pain , magnetic resonance angiography , varicocele , flank pain , magnetic resonance imaging , angiography , superior mesenteric artery , physical examination , surgery , left renal vein , inferior vena cava , infertility , pregnancy , genetics , biology , blood pressure
The nutcracker phenomenon [left renal vein (LRV) entrapment syndrome] refers to compression of the LRV most commonly between abdominal aorta and superior mesenteric artery. Term of nutcracker syndrome (NCS) is used for patients with clinical symptoms associated with nutcracker anatomy. LRV entrapment divided into 2 types: anterior and posterior. Posterior and right-sided NCSs are rare conditions. The symptoms vary from asymptomatic hematuria to severe pelvic congestion. Symptoms include hematuria, orthostatic proteinuria, flank pain, abdominal pain, varicocele, dyspareunia, dysmenorrhea, fatigue and orthostatic intolerance. Existence of the clinical features constitutes a basis for the diagnosis. Several imaging methods such as Doppler ultrasonography, computed tomography angiography, magnetic resonance angiography and retrograde venography are used to diagnose NCS. The management of NCS depends upon the clinical presentation and the severity of the LRV hypertension. The treatment options are ranged from surveillance to nephrectomy. Treatment decision should be based on the severity of symptoms and their expected reversibility with regard to patient's age and the stage of the syndrome.