Discriminating renal nutcracker syndrome from asymptomatic nutcracker phenomenon using multidetector computed tomography

Abstract

The combination of SMA-aortic angle and visualization of a dilated collateral vein with reflux in multidetector CT can be useful to differentiate NCS from asymptomatic NCP.

CT imaging findings of abdominopelvic vascular compression syndromes: what the radiologist needs to know

“…4), or more rarely between the aorta and a vertebral body, recognized as "posterior nutcracker" or "pseudo-nutcracker syndrome" (Fig. 5) [13,14]. The definite prevalence of NCS is unclear due to the high variability in clinical manifestations [15,16].…”

“…Anterior NCS may coexist with SMA syndrome due to their common pathogenesis [1]. Rapid loss of weight and retroperitoneal fat, ptosis of the left kidney, preaortic fibrous tissue, and duodenal interposition have been reported as predisposing factors for NCS [1,13].…”

Nutcracker Syndrome: An Update on Current Diagnostic Criteria and Management Guidelines

“…Hence the term NCS should be limited to patients who present with the characteristic clinical signs and symptoms, 5 specifically haematuria, proteinuria, flank pain, pelvic congestion in females, and varicocele in male patients, 6 alongside diagnostic imaging of the anatomy associated with the syndrome. 5,7,8 This is important, as asymptomatic dilatation of the LRV found on diagnostic imaging such as Doppler ultrasound (DUS) and computed tomography (CT), is considered to be a normal variant. 9 This review aims to identify the common clinical presentations, key diagnostic criteria, and diagnostic accuracy of various imaging modalities for NCS, as well as reporting follow-up data on different NCS management strategies ranging from conservative to open surgery and endovascular techniques.…”

Vascular compression of left renal vein: the nutcracker phenomenon

“…If symptomatic, it is known as nutcracker syndrome (NCS) 1. The imaging equivalent of this phenomenon is the nutcracker sign.…”

“…Clinical manifestations include left flank pain, haematuria, gonadal varices, hypertension and renal vein thrombosis. About one-third of the patients with vascular compression develop symptoms 1. If symptomatic, treatment is usually by endovascular methods 3…”