Anterior Nutcracker syndrome as a rare cause of hematuria in an 8 year old boy: A case report (original) (raw)
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Nutcracker Syndrome Due to Left Renal Vein Compression by an Aberrant Right Renal Artery
American Journal of Kidney Diseases, 2007
Classic nutcracker syndrome is caused by left renal vein compression between the superior mesenteric artery and aorta, leading to retrograde venous hypertension associated with such urinary abnormalities as hematuria or proteinuria. We describe a case of symptomatic nutcracker syndrome treated by means of stent placement in which hypertension in the left renal vein was caused by stenosis of this vein compressed by an aberrant right renal artery at a point closer to the inferior vena cava. Am J Kidney Dis 50:326-329.
Endovascular intervention to a rare cause of hematuria: Nutcracker syndrome - A case report
Cardiovascular Surgery and Interventions, 2019
Nutcracker phenomenon is described as the compression of the left renal vein between the superior mesenteric artery and aorta. Nutcracker syndrome (NCS) refers to clinical manifestations of the Nutcracker phenomenon. Although asymptomatic cases do not often require any intervention, symptomatic cases can be treated with medial nephropexy and excision of the renal varices, left renal vein bypass, transposition of the left renal vein, or stent placement in the left renal vein. Herein, we present a case with NCS and its management with endovascular intervention.
Nutcracker syndrome: an overlooked cause of hematuria
Chang Gung medical journal, 2002
Nutcracker syndrome is caused by compression of the left renal vein between the aorta and the superior mesenteric artery, where it courses in the fork formed at the bifurcation of these arteries. The phenomenon results in left renal venous hypertension, which leads to left renal vein and left gonadal vein varices and unilateral hematuria. The main presenting symptom is hematuria, with or without left flank pain. The disorder is easily missed by routine diagnostic methods. Its incidence is likely underestimated. We report on a 25-year-old woman who experienced intermittent gross hematuria and left flank pain. The diagnosis of nutcracker syndrome was missed initially. Abdominal computed tomography, angiography, venography, and magnetic resonance angiography, which were later performed, showed that the left renal vein was compressed between the aorta and the superior mesenteric artery. The pressure gradient between the left renal vein and the inferior vena cava was 6.8 cm H2O. A diagno...
A Rare Cause of Recurrent Hematuria in Children: Nutcracker Syndrome
Journal of Tropical Pediatrics, 2009
Nutcracker syndrome (NCS), the left renal vein hypertension due to compression between aorta and superior mesenteric artery, may present with hematuria, flank pain and proteinuria. We report a 6-year-old girl with episodic macroscopic hematuria who was diagnosed as NCS with Doppler ultrasound and 3D computerized tomography angiography. She was managed conservatively with spontaneous resolution of macroscopic hematuria. With this case we would like to emphasize that in children with hematuria and orthostatic proteinuria without an apparent cause, a great index of suspicion and appropriate imaging is necessary for the diagnosis of NCS.
Atypical Posterior Nutcracker Syndrome in a 17-Year-Old Male Without Hematuria
Cureus, 2021
Retro-aortic left renal vein (RLRV) is an anatomical variation, where the left renal vein (LRV) courses posterior to the aorta and anterior to the vertebrae before it eventually drains into the inferior vena cava (IVC). RLRV is a rare finding, with a prevalence of around 1%-2%, and only a small minority of RLRVs cause symptoms. RLRV symptoms occur secondary to compression of the LRV between the abdominal aorta and vertebrae, otherwise known as posterior nutcracker syndrome (PNCS). The most common symptoms of PNCS are hematuria and flank pain. We present a 17-year-old male, who came in with recurring left flank pain without hematuria, initially thought to be renal colic secondary to nephrolithiasis. On further investigations, an aberrant posterior renal vein was seen on CT suggestive of PNCS. The patient was treated successfully with RLRV vascular stent placement by interventional radiology. This case report adds to the limited number of PNCS cases observed in children and to the eve...
Recurrent Hematuria Caused by Nutcracker Syndrome
Annals of Vascular Surgery, 2013
A 26-year-old woman presented to the emergency department complaining of left flank pain, and proteinuria and hematuria were detected during urinalysis. A renal ultrasound did not reveal any disorder, and after performing a computed tomography angiography scan, compression of the left renal vein between the superior mesenteric artery and the aorta was seen. This compression is known as Nutcracker syndrome. From among the different treatment options available, it was decided, with patient consensus, to use open surgical management, performing a transposition of the left renal vein to a more distal level in the inferior vena cava. The immediate postoperative care progressed without complications and the symptoms resolved; after 1 year of surveillance, the patient continues to be asymptomatic. Nutcracker syndrome is a rare phenomenon, with few cases described. There are different therapeutic options for the treatment of Nutcracker syndrome, such as open surgery, endovascular treatment, or conservative treatment; because of the low prevalence of this syndrome, there are no sufficiently large series at present or with the necessary long-term surveillance to decide on the most suitable treatment. Distal transposition of the left renal vein in the inferior cava vein has proved to offer good long-term results, and this option offers a higher chance of resolution without the need for as many postsurgery controls as would be required with endovascular treatment.
Endovascular treatment of a teenager with nutcracker syndrome: a case report
Jornal Vascular Brasileiro, 2020
The nutcracker syndrome is caused by compression of the left renal vein by the superior mesenteric artery and aorta and is associated with characteristic symptoms, such as lower abdominal pain, varicocele, and hematuria. Diagnosis is often difficult and, therefore, is often delayed. Invasive treatment is controversial, particularly in pediatric patients. However, it is indicated in cases of gross hematuria associated with anemia, renal function impairment, severe pelvic pain, or ineffective conservative treatment. We report the case of a 12-year-old boy presenting with severe hematuria for 12 hours, with no abnormal findings at a first evaluation, who progressed with severe anemia and urinary retention. Further investigation provided images suggestive of nutcracker syndrome, and endovascular stenting (smart control stent) followed by balloon dilatation was the treatment of choice. Hematuria ceased after the procedure, and the patient is still asymptomatic at 5-year follow-up.
Gross hematuria of uncommon origin: The nutcracker syndrome
American Journal of Kidney Diseases, 1998
Left renal vein hypertension, also called ''nutcracker phenomenon'' or ''nutcracker syndrome,'' is a rare vascular abnormality responsible for gross hematuria. The phenomenon is attributable to the idiopathic decrease in the angle between the aorta and the superior mesenteric artery with consequent compression of the left renal vein. The entrapment of the left renal vein is not easily detectable by ordinary diagnostic procedures. We report two cases of gross hematuria (persistent in one patient and recurrent in the other) caused by ''nutcracker phenomenon.'' In both cases, no remarkable findings were obtained from medical history, urinary red blood cells morphology, repeated urinalysis, pyelography, cystoscopy, or ureteroscopy. Left renal vein dilation in one case was found with a computed tomography (CT) scan performed on the venous tree of left kidney. The diagnosis of ''nutcracker phenomenon'' was confirmed by renal venography with measurement of pressure gradient between left renal vein and inferior vena cava in both cases. In one case, the diagnosis was complicated by the presence of Mycobacterium tuberculosis in urine. The ''nutcracker phenomenon'' is probably more common than thought. Early diagnosis is important to avoid unnecessary diagnostic procedures and complications such as the thrombosis of the left renal vein. Many procedures are available to correct the compression of the left renal vein entrapped between the aorta and the superior mesenteric artery: Gortex graft vein interposition, nephropexy, stenting, and kidney autotransplantation. After surgery, gross hematuria ceases in almost all patients.
Current Trends in the Diagnosis and Management of Renal Nutcracker Syndrome: A Review
European Journal of Vascular and Endovascular Surgery, 2006
Nutcracker syndrome is caused by compression of the left renal vein between the aorta and the superior mesenteric artery where it passes in the fork formed at the bifurcation of these arteries. The phenomenon results in left renal venous hypertension. The syndrome is manifested by left flank and abdominal pain, with or without unilateral haematuria. Other common presentation is as 'pelvic congestion syndrome' characterized by symptoms of dysmenorrhea, dyspareunia, postcoital ache, lower abdominal pain, dysuria, pelvic, vulvar, gluteal or thigh varices and emotional disturbances. Likewise compression of the left renal vein can cause left renal-to-gonadal vein reflux resulting in lower limb varices and varicoceles in males. Its diagnosis is based on history and physical examination, basic lab tests to exclude other causes of haematuria, cystoscopy and ureteroscopy to confirm unilateral haematuria and exclude other causes of this sinister symptom. Sequence of imaging has more or less been rationalised to USS with Doppler studies, CT or MR angiography and finally phlebography with renal vein and IVC manometery to confirm the diagnosis.
TheScientificWorldJournal, 2011
Nutcracker syndrome is described as the symptomatic compression of left renal vein between the aorta and the superior mesenteric artery, resulting in outflow congestion of the left kidney. We present the case of a 51-year-old male with a left-sided inferior vena cava, resulting in compression of the right renal vein by the superior mesenteric artery. Secondary to this anatomic anomaly, the patient experienced a many-year history of flank pain and intermittent gross hematuria. We have termed this unusual anatomic finding and its associated symptoms as the "inverted nutcracker syndrome", and describe its successful management with nephrectomy and autotransplantation.