Left renal vein hypertension in patients with left renal bleeding of unknown origin.

Nishimura, Yasuhiko; Fushiki, Masato; Yoshida, Midori; Nakamura, Kôsuke; Imai, Michio; Ono, Takeharu; Morikawa, Shuji; Hatayama, Takashi; Komatz, Y

doi:10.1148/radiology.160.3.3737903

Cited by 93 publications

(53 citation statements)

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“…[48][49][50] It varies from microhematuria to macrohematuria, occasionally with resultant anemia that requires blood transfusions. 3,[50][51][52][53][54][55] Cystoscopy may identify a left ureteral origin. 22,24,50,56,57 In a study by Shin et al, 30 the causes of isolated hematuria could not be identified by routine methods in 69% of pediatric cases.…”

Section: Clinical Featuresmentioning

confidence: 99%

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Nutcracker Phenomenon and Nutcracker Syndrome

Kurklinsky¹,

Rooke

2010

Mayo Clinic Proceedings

418

542

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N utcracker phenomenon (NCP), also known as left renal vein entrapment,1-3 is characterized by impeded outflow from the left renal vein (LRV) into the inferior vena cava (IVC) due to extrinsic LRV compression, often accompanied by demonstrable lateral (hilar) dilatation and medial (mesoaortic) narrowing (schematic representation of NCP/ nutcracker syndrome [NCS] in Figure 1). Although the terms nutcracker syndrome and nutcracker phenomenon are sometimes used interchangeably in the literature, Shin and Lee 4 emphasize that the nutcracker anatomy is not always associated with clinical symptoms and that some of the anatomic findings suggestive of nutcracker may represent a normal variant or be accounted for by other conditions. Therefore, the term nutcracker syndrome should be reserved for patients with characteristic clinical symptoms associated with demonstrable nutcracker morphologic features. No consensus exists on what symptoms are severe enough to warrant the designation of a clinical syndrome or to what extent various findings may simply reflect different evolutionary stages of the process. Because of these uncertainties, some authors focus on the characteristic anatomic and hemodynamic findings, referring to them as NCP rather than NCS. 5Nutcracker phenomenon refers to compression of the left renal vein, most commonly between the aorta and the superior mesenteric artery, with impaired blood outflow often accompanied by distention of the distal portion of the vein. The nutcracker syndrome (NCS) is the clinical equivalent of nutcracker phenomenon characterized by a complex of symptoms with substantial variations. Depending on specific manifestations, NCS may be encountered by different medical specialists. Although it may be associated with substantial morbidity, the diagnosis of NCS is often difficult and is commonly delayed. Diagnostic and treatment criteria are not well established, and the natural history of NCS is not well understood. We performed an initial review of the literature through MEDLINE, searching from 1950 to date and using the keywords nutcracker syndrome, nutcracker phenomenon, and renal vein entrapment. We performed additional reviews based on the literature citations of the identified articles. We attempted to elucidate clinical relevance of these conditions and their prominent features and to summarize professional experience. Mayo Clin

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Section: Clinical Featuresmentioning

confidence: 99%

“…On the basis of these data, LRV hypertension occurs when the gradient is 3.0 mm Hg. 53,54 Normal left gonadal vein diameter approximates 3 mm. 37,58,93 Ovarian veins (left more commonly than right) can show reflux in healthy asymptomatic parous women.…”

Section: Normal Anatomic and Physiologic Findingsmentioning

confidence: 99%

Nutcracker Phenomenon and Nutcracker Syndrome

Kurklinsky¹,

Rooke

2010

Mayo Clinic Proceedings

418

542

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“…This anomaly has an incidence of 0.8% to 3.7% (34). This is usually asymptomatic, but (45,46). Knowledge of this anomaly is essential before renal and adrenal venography, renal venous renin sampling, left renal transplant and splenorenal shunt.…”

Section: Retroaortic Left Renal Veinmentioning

confidence: 99%

Congenital anomalies of the IVC—embryological perspective and clinical relevance

Ghandour¹,

Partovi²,

Karuppasamy³

et al. 2016

Cardiovasc. Diagn. Ther.

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With the increased use of cross-sectional imaging, systemic venous anomalies are more frequently being recognized in asymptomatic patients. Accurate characterization of systemic venous anomalies plays a major role in the appropriate selection of a surgical approach or interventional procedure.In this article, we review common and uncommon inferior vena cava (IVC) anomalies. We describe the embryological basis and clinical implications of these anomalies, particularly from an interventional radiology perspective. We also discuss the complications and treatments of these anomalies.

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“…37 In addition to hematuria, proteinuria, and varicocele, often asymptomatic nutcracker syndrome may result in ovarian vein syndrome, LRV hypertension, and pelviureteral varices. 38 The diagnostic procedure considered the reference standard for establishing the diagnosis of nutcracker syndrome is invasive selective left renal phlebography with measurement of the pressure gradient between the LRV and inferior vena cava (pressure in the LRV -pressure in inferior vena cava ≥3 mm Hg is considered a cutoff value for the diagnosis of the nutcracker syndrome 39 ). The sonographic diagnostic criterion consists of a peak flow velocity ratio between the AMP and hilar portion of the LRV of greater than 5.…”

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confidence: 99%

Varicocele and Nutcracker Syndrome

Mohamadi

Ghasemi-Rad

Mladkova

et al. 2010

Journal of Ultrasound in Medicine

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Abbreviations AMP, aortomesenteric portion; ANOVA, analysis of variance; LRV, left renal vein lthough the causes of infertility in men are of various characters and origins (eg, developmental defects and exposure to harmful agents), a substantial proportion, especially secondarily infertile men, have the clinically detectable and correctable vascular abnormality varicocele.Despite various theories, the underlying cause of varicocele remains enigmatic. The role of intrinsic anatomic differences between the left and the right renal vein drainage systems has been implicated in the development of this condition. A greater length of the left internal spermatic vein in comparison with the right system and higher venous pressure on the left side caused by the junction of the left internal spermatic vein with the left renal vein (LRV) at a right angle are the most commonly considered factors because they lead to subsequent propagation of the elevated pressure to the left scrotal vein 1 and possibly determine the onset of varicocele. A ArticleObjective. Varicocele is a vascular lesion commonly associated with infertility. Its etiology is only partly understood; hence, the purpose of the study was to establish its correlation with intrinsic anatomic differences and nutcracker syndrome. Methods. A total of 93 patients with varicocele and 76 patients without varicocele were enrolled. The diagnosis of varicocele was based on physical examination, followed by sonographic evaluation of the hilar portion and aortomesenteric portion (AMP) of the left renal vein (LRV). The anteroposterior diameter in millimeters and peak flow in centimeters per second in each region were measured. Results. A total of 28 patients with the nutcracker syndrome were identified in the study group (30.10%), and 2 were identified in the control group (2.63%). The mean diameters of the hilar portion and AMP of the LRV were significantly different in varicocele-affected patients compared with the control group (P < .0001 for both). The mean peak velocities in the hilar portion and AMP were significantly different in patients with varicocele (P < .0001). Patients with varicocele and nutcracker syndrome did not have a significant difference in either the hilar or AMP diameter compared with patients with varicocele without nutcracker syndrome. They had a significant difference in both the hilar and AMP peak flow velocity (P = .0001 for both). Conclusions. Our findings indicate that nutcracker syndrome is a frequent finding in varicocele-affected patients and should be routinely excluded as a possible cause of varicocele. In addition, intrinsic anatomic differences in the AMP and hilar portion of the LRV could be directly responsible for the onset of varicocele.

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Left renal vein hypertension in patients with left renal bleeding of unknown origin.

Cited by 93 publications

References 0 publications

Nutcracker Phenomenon and Nutcracker Syndrome

Nutcracker Phenomenon and Nutcracker Syndrome

Congenital anomalies of the IVC—embryological perspective and clinical relevance

Varicocele and Nutcracker Syndrome

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