A Case of Nutcracker Syndrome Combined with Wilkie Syndrome with Unusual Clinical Presentation

Farina, R.; Iannace, Francesco Aldo; Foti, Pietro Valerio; Conti, Alessio; Inì, Corrado; Libra, Federica; Fanzone, Luigi; Coronella, Maria; Santonocito, Serafino; Basile, Antonio

doi:10.12659/ajcr.922715

Cited by 20 publications

(37 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The results are summarized in Table 1 . Chest MDCT angiography examination showed enhancement defects in some branches of the right pulmonary artery compatible with pulmonary embolism ( Figure 4A, 4B ), double stenosis of the LCIV ( Figure 4C, 4D ), partial thrombosis of the LCIV, compression syndromes [ 12 ]. The measurements of the PSV values in the LCIV performed with duplex Doppler ultrasound were very important because they allowed us to have information on the degree of stenosis through the calculation of flow ratio.…”

Section: Discussionmentioning

confidence: 99%

May-Thurner Syndrome with Double Compression of the Iliac Vein: Lessons Based on a Case Report

et al. 2021

Self Cite

View full text Add to dashboard Cite

Patient: Female, 73-year-old Final Diagnosis: May-Thurner syndrome with double stenosis of the left common iliac vein Symptoms: Acute onset of worsening dyspnea, with lymphedema of the left lower limb Medication: — Clinical Procedure: — Specialty: Diagnostics, Laboratory • Radiology Objective: Rare disease Background: May-Thurner syndrome, also known as Cockett’s syndrome, is characterized by vascular alterations due to stenosis of the left iliac vein, usually caused by compression against the vertebral column by the right iliac artery. Doppler ultrasound represents the first level of examination for the study of this vascular pathology, and allows a very accurate study of the lower-limb vessels. We describe an unusual presentation with double stenosis of the left common iliac vein. Case Report: A 73-year-old woman came to the clinic for acute onset of worsening dyspnea, with lymphedema of the left lower limb, and was examined using ultrasound and multidetector computed tomography. The Doppler ultra-sound exam showed 2 compressions of the common iliac vein by the right and left iliac artery due to a combination of osteophytosis of the vertebral column and reduced distance between the left iliac vein and the spine. Conclusions: May-Thurner syndrome should be suspected in patients with symptoms of venous stasis of the left lower limb. Doppler ultrasound identified stenosis of the common iliac vein and the consequent flow changes. Failure to diagnose and treat May-Thurner syndrome could expose patients to very serious risks to their health.

show abstract

Section: Discussionmentioning

confidence: 99%

May-Thurner Syndrome with Double Compression of the Iliac Vein: Lessons Based on a Case Report

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…In cases with light compression of the IJV and in patients who decline surgical treatment, we recommend a follow-up with DUS at 6 or 12 months. Failure to treat these patients, as in the case of other vascular compression syndromes [ 19 – 21 ], could have very serious consequences for the patients’ health.…”

Section: Discussionmentioning

confidence: 99%

Stylo-Jugular Venous Compression Syndrome: Lessons Based on a Case Report

et al. 2021

Self Cite

View full text Add to dashboard Cite

Patient: Female, 28-year-old Final Diagnosis: Nutcracker phenomenon • Wilkie syndrome Symptoms: Epigastric pain • rapid weight loss • abdomen was tense and painful and pain increased after compression Medication: — Clinical Procedure: — Specialty: Radiology Objective: Unusual clinical course Background: Eagle syndrome is a vascular compression syndrome that is caused by a very elongated styloid process and/or calcification of the stylohyoid ligament compressing the vascular or nerve structures of the neck, resulting in vascular congestion, thrombosis, or neurological symptoms (eg, dysphagia, neck pain, ear pain). Stylo-jugular venous compression syndrome is a subtype of Eagle syndrome and is caused by compression of the internal jugular vein. Treatment varies according to the symptoms and the severity of the compression, and it can be pharmacological or surgical, with vascular stenting and/or removal of the styloid process. We describe a rare case of left cerebral venous sinus thrombosis and ipsilateral internal jugular vein stenosis sustained by excessive length of the left styloid process. Case Report: A 36-year-old woman presented with recurrent episodes of drug-resistant headache and recent memory disturbances. She underwent cerebral and neck multidetector computed tomography-angiography and Doppler ultrasound of the epiaortic vessels that respectively revealed thrombosis of the left cerebral venous sinus and left internal jugular vein stenosis due to a very long styloid process. The patient was treated with anticoagulant drugs and experienced a gradual remission of symptoms. Conclusions: Compression of the jugular vein by the styloid process is a rare entity, and it often goes undiagnosed when it is asymptomatic. Doppler ultrasound is a sensitive method for identifying jugular vein stenosis and can provide an estimated degree of stenosis, which is useful for treatment planning. Doppler ultrasound should be combined with multidetector computed tomography-angiography to rule out compression of other vascular structures and other causes of compression. Failure to treat these patients could have serious health consequences for them.

show abstract

“…In the “renal collar” condition, the concomitant compression of the anterior LRV (between the abdominal aorta and superior mesenteric artery) and the posterior LRV (between the abdominal aorta and spine) results in “combined nutcracker syndrome" [ 12 ]. Doppler ultrasound is the first-line imaging which allows detection of left renal vein stenosis, possible renal failure and varicocele secondary to venous congestion in the LRV, which require more accurate study with contrast-enhanced computed tomography (CE-CT) [ 10 , 12 , 13 ]. A CE-CT scan provides accurate detection of vascular structures and their relationship to adjacent organs and allows excluding other causes of compression [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Posterior nutcracker syndrome: a case report

Gozzo¹,

Farina²,

Foti³

et al. 2021

J Med Case Reports

Self Cite

View full text Add to dashboard Cite

Background Posterior nutcracker syndrome is defined by the compression of the left renal vein between the abdominal aorta and a lumbar vertebral body. It can be clinically manifest with intermittent hematuria, gonadal or spermatic reflux resulting in varicocele. Ultrasound is the first-line imaging which require more accurate study with contrast-enhanced computed tomography. Management can be conservative in younger patients with mild hematuria due to the high spontaneous remission rate and invasive with open surgical and endovascular interventions. We describe a very rare case with compression of the left renal vein due to an osteophyte of the spine. Case presentation A 62-year-old Caucasic male came to our radiology department for chronic hepatitis B virus (HBV)-related liver disease follow-up and mild scrotal pain. The ultrasound examination revealed a compression of the left retro-aortic renal vein in the aorto-vertebral space caused by an osteophyte. Duplex Doppler ultrasound revealed flow congestion in the left renal vein and renal failure; power Doppler ultrasound showed left varicocele. Conclusions Doppler ultrasound is the first-line imaging and allows the detection of all the typical signs of posterior nutcracker: left renal vein stenosis, flow congestion and renal failure. Nutcracker syndrome should be suspected in older patients with left varicocele associated with hematuria. Failure to diagnose and treat these patients could have serious consequences for their health.

show abstract

A Case of Nutcracker Syndrome Combined with Wilkie Syndrome with Unusual Clinical Presentation

Cited by 20 publications

References 15 publications

May-Thurner Syndrome with Double Compression of the Iliac Vein: Lessons Based on a Case Report

May-Thurner Syndrome with Double Compression of the Iliac Vein: Lessons Based on a Case Report

Stylo-Jugular Venous Compression Syndrome: Lessons Based on a Case Report

Posterior nutcracker syndrome: a case report

Contact Info

Product

Resources

About