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Nutcracker Syndrome: Symptoms, Diagnosis, and Treatment

Definition

Nutcracker syndrome is the compression of the left renal vein between the superior mesenteric artery and the aorta (Kurklinsky et al., 2010).

Signs and Symptoms of Nutcracker Syndrome

The symptoms are nonspecific and variable in intensity: Left flank pain, hematuria, proteinuria, or varicocele. Typical is an aggravation when sitting and standing.

Diagnosis:

• Renal ultrasound imaging with Doppler ultrasound of the renal vein: nutcracker syndrome increasis mean peak velocity of the renal vein at the mesenteric artery.
• Angiographic CT: diameter change of the left renal vein (beak sign), jet flow of contrast into the inferior vena cava, visible collateral vessels.
• Venography (retrograde phlebography)

Treatment of Nutcracker Syndrome

The challenge is correlating the clinical findings and symptoms with the imaging results. A wait-and-see behavior is recommended for mild disease, collateral vessels will form and alleviate the symptoms. Percutaneous stent insertion or open surgical therapy (transposition of the renal vein) are options in patients with severe symptoms.

References

Kurklinsky, A. K. & Rooke, T. W. Nutcracker phenomenon and nutcracker syndrome.
2010, 85, 552-559.

  Deutsche Version: Diagnose und Therapie des Nussknacker-Syndroms