Evaluation of left renal vein entrapment using multidetector computed tomography

Abstract

Left renal vein entrapment is not a rare entity and renal nutcracker phenomenon might be underdiagnosed.

Association of Congenital Left Renal Vein Anomalies and Unexplained Hematuria: Multidetector Computed Tomography Findings

“…Nutcracker syndrome, an anomaly arising due to compression of the left renal vein between the aorta and the superior mesenteric artery or vertebra, has been reported to lead to increased pressure in the left renal vein and venous congestion in the kidney, and to manifest itself with left flank pain, hypertension or hematuria in some patients presenting with hematuria or flank pain and with no identified underlying pathology capable of accounting for this [4,5,6,7,8,9]. However, there is no information in the literature regarding whether or not congenital renal vein malformations, such as CLRV, RLRV and MRV, lead to hematuria.…”

“…Although these renal vein anomalies are generally regarded as following a quiescent course with no clinical findings, there are also case reports and studies that suggest the spontaneous complications of left renal vein anomalies may occur related to the nutcracker syndrome in its different forms [4,5,6,7,8,9]. Various studies have reported that nutcracker syndrome, an anomaly arising as a result of the left renal vein being compressed between the aorta and superior mesenteric artery or vertebra, leads to increased pressure in the left renal vein and venous congestion in the kidney, and this condition manifests itself with left flank pain and hematuria [4,5,6].…”

“…Various studies have reported that nutcracker syndrome, an anomaly arising as a result of the left renal vein being compressed between the aorta and superior mesenteric artery or vertebra, leads to increased pressure in the left renal vein and venous congestion in the kidney, and this condition manifests itself with left flank pain and hematuria [4,5,6]. There is no detailed information in the literature, however, regarding whether congenital renal vein anomalies, such as CLRV, RLRV and MRV, lead to hematuria.…”

Imaging of venous compression syndromes

“…NCS is characterized by symptomatic compression of the left renal vein (LRV) between the abdominal aorta posteriorly and superior mesenteric artery (SMA) anteriorly (1-4,52-57). If asymptomatic, it is called nutcracker phenomenon (NCP) (52,56,57). NCS is also known as mesoaortic LRV compression, LRV entrapment syndrome, and "anterior" NCS (1,54,56,57).…”

“…If asymptomatic, it is called nutcracker phenomenon (NCP) (52,56,57). NCS is also known as mesoaortic LRV compression, LRV entrapment syndrome, and "anterior" NCS (1,54,56,57). A "posterior" NCS has also been described (approximately 20% of all NCS) cases, in which a circumaortic (17%) or retroaortic (3%) LRV is compressed between the aorta and vertebral body (54,(56)(57)(58).…”