Nutcracker syndrome: A rare cause of left flank pain that can also manifest as unexplained pelvic pain

Berthelot, Jean‐Marie; Douane, Frédéric; Maugars, Yves; Frampas, É.

doi:10.1016/j.jbspin.2016.10.006

Cited by 25 publications

(49 citation statements)

References 54 publications

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“…Gonadal, asendan lomber, üreteral, adrenal kapsüler venler SRV kompresyonu ve obliterasyonu olan hastalarda iyi bilinen kolateral yollardır. Afferent venöz sistemde oluşan bu basınç artışı kadınlarda pelvik konjesyon sendromu, erkeklerde ise varikosel ile sonuçlanabilir (10)(11)(12)(13). Birkaç çalışmada RSRV ve ovaryan vende basınç artışının, ovaryan ven sendromunun ve pelvik konjesyon sendromunun nadir nedenleri arasında olduğu ileri sürülmüştür (11,14).…”

Section: Gereç Ve Yöntemlerunclassified

“…Nutcracker sendromunda (NCS), SRV'nin superiyor mezenterik arterle aorta arasında sıkışmasına veya retroaortik seyrederek aorta ile vertebra arasında sıkışmasına bağlı renal venöz hipertansiyon görülür. Bu hastalarda en yaygın klinik bulgular sol yan ağrısı, hematüri, ortostatik proteinüri gibi üriner semptomlar ve varikosel, infertilite, disparoni, pelviste variköz venlerle karakterize pelvik konjesyon gibi jinekolojik semptomlardır (10). Bu çalışmada SGV çapındaki artış venöz hipertansiyonu, RSRV grubunda kontrol grubuna kıyasla istatistiksel anlamlı fazla bulunan pelvik variköz venöz yapılar pelvik konjesyonu desteklemektedir.…”

Section: Gereç Ve Yöntemlerunclassified

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Clinical and Radiological Significance of the Retroaortic Left Renal Vein

Aktaş

2019

Anadolu Kliniği Tıp Bilimleri Dergisi

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ÖzAmaç: Retroaortik sol renal ven (RSRV), saptanma sıklığı son yıllarda artan radyolojik görüntülemeye paralel olarak görece artmış bulunan, genellikle asemptomatik bir anatomik varyasyondur. Çalışmamızda RSRV'li asemptomatik hastalarda ven basıncı artışı olup olmadığını incelemeyi amaçladık. Gereç ve Yöntemler: Kontrastlı bilgisayarlı tomografide RSRV saptanan 138 hasta (RSRV grubu) ve bu hastalarla yaş ve cinsiyet bakımından benzer 100 kişi (kontrol grubu) çalışmaya dahil edildi. Sol renal ven çapı, en dar olduğu segmentte RSRV çapı ve sol gonadal ven çapı ölçülüp karşılaştırıldı. Bulgular: RSRV ve kontrol grupları karşılaştırıldığında preaortik segmentte sol renal ven çapı RSRV'li hastalarda anlamlı olarak daha geniş bulundu. Bu hastalarda sol gonadal ven çapının da artmış olduğu görüldü. Tartışma ve Sonuç: RSRV, sıklıkla asemptomatik olmakla birlikte, sol renal venin aorta arkasında sıkışmasıyla sol renal ven ve gonadal venlerde basınç artışına neden olabilir. Bu basınç artışı kadınlarda pelvik konjesyon, erkeklerde ise varikosel etiyolojisinde önemlidir. Aynı zamanda hematüri ve yan ağrısı gibi klinik semptomlara da yol açabilir. Anahtar Sözcükler: bilgisayarlı tomografi; pelvik konjesyon; retroaortik sol renal ven Abstract Aim: Retroaortic left renal vein (RLRV) is a usually asymptomatic anatomical variation whose detection frequency has increased relatively in parallel with the recently increased use of radiological imaging. In this study, we aimed to investigate if there is increased vein pressure in asymptomatic patients with RLRV. Materials and Methods: A total of 138 patients diagnosed with RLRV by contrast-enhanced computed tomography (the RLRV group) and 100 participants (the control group) with similar age and sex characteristics were included. Left renal vein diameter, RLRV diameter at the narrowest segment, and left gonadal vein diameter were measured and compared. Results: When the RLRV and control groups were compared, left renal vein diameter at the preaortic segment was found to be significantly greater in the patients with RLRV. Left gonadal vein diameter also was observed to have increased in these patients. Discussion and Conclusion: RLRV, though usually asymptomatic, can cause increased pressure in the left renal vein and gonadal veins by compressing the left renal vein posteriorly to the aorta. This pressure increase is important in the etiology of pelvic congestion in women and varicocele in men. It can also lead to clinical symptoms such as flank pain and hematuria.

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Section: Gereç Ve Yöntemlerunclassified

Clinical and Radiological Significance of the Retroaortic Left Renal Vein

Aktaş

2019

Anadolu Kliniği Tıp Bilimleri Dergisi

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“…13,14 Treatment is indicated in patients with severe symptoms, such as intense hematuria, combined or not with anemia, intense pelvic pain and pain in the abdominal flank, or symptoms persisting for more than 6 months in adults and 24 months in those less than 18 years old. 3,5,15,16 Surgical treatment is necessary to avoid development of chronic glomerulopathy and compromised renal function, permanent dilatation of the gonadal vein, and thrombosis of the renal vein. 5,15 Open surgery methods have been associated with greater morbidity, when compared to less invasive methods, because of the prolonged period of renal congestion, the need for additional anastomoses, and the extensive dissection involved.…”

Section: Surgical Treatmentmentioning

confidence: 99%

“…3,5,15,16 Surgical treatment is necessary to avoid development of chronic glomerulopathy and compromised renal function, permanent dilatation of the gonadal vein, and thrombosis of the renal vein. 5,15 Open surgery methods have been associated with greater morbidity, when compared to less invasive methods, because of the prolonged period of renal congestion, the need for additional anastomoses, and the extensive dissection involved. 5 Open surgery for anterior nutcracker syndrome a) Transposition of the LRV: this is the most common and effective surgery for treatment of anterior nutcracker syndrome and was first used for this purpose in 1982 by Stewart et al.…”

Section: Surgical Treatmentmentioning

confidence: 99%

Diagnóstico e tratamento da síndrome de quebra-nozes (nutcracker ): revisão dos últimos 10 anos

et al. 2018

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Resumo A síndrome de quebra-nozes é caracterizada por um grupo de manifestações clínicas que ocorrem por conta da compressão da veia renal esquerda. Seus principais sintomas são macro e micro-hematúria, proteinúria e dor no flanco. O diagnóstico é geralmente realizado após a exclusão de outras causas mais comuns, por conta da ausência de critérios clínicos para diagnóstico. Sua confirmação é feita por exames de imagem, com uso da ultrassonografia Doppler e tomografia computadorizada. O tratamento pode variar com as características do paciente e com a gravidade dos sintomas, e inclui o tratamento conservador, a cirurgia aberta e a cirurgia endovascular. Atualmente, a cirurgia aberta continua sendo a linha de frente, mas abordagens menos invasivas vêm ganhando cada vez mais espaço.

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“…The hematuria is believed to be the result of an increase in pressure within the LRV that weakens its walls, leading to the predisposition for rupture of the septum between the small veins and the collecting system [ 6 , 7 , 81 , 87 , 89 ]. Hematuria is most often microscopic, and when macroscopic (< 20% of patients) is also often intermittent [ 81 , 90 ]. The flank pain has been attributed to inflammatory processes secondary to the LRV constriction or urethral colic with the passage of blood clots [ 6 , 82 , 87 ].…”

Section: Introductionmentioning

confidence: 99%

Co-occurring superior mesenteric artery syndrome and nutcracker syndrome requiring Roux-en-Y duodenojejunostomy and left renal vein transposition: a case report and review of the literature

Heidbreder

2018

J Med Case Reports

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BackgroundThe duodenum and the left renal vein occupy the vascular angle made by the superior mesenteric artery and the aorta. When the angle becomes too acute, compression of either structure can occur. Each type of compression is associated with specific clinical symptoms that constitute a rare disorder. If clinical symptoms are mild, conservative treatment is implemented. However, surgery is often the only solution that can improve quality of life and/or avoid life-threatening complications. This report describes a case of a patient with both types of aortomesenteric compression that required two separate surgeries to alleviate all symptoms.Case presentationA 20-year-old white woman presented to the Emergency Room complaining of sudden onset severe left flank and lower left quadrant abdominal pain, nausea, and vomiting. A clinical work-up revealed elevated white blood cells and hematuria. She was discharged with a diagnosis of urinary tract infection. Symptoms continued to worsen over the subsequent 2 months. Repeated and extensive clinical work-ups failed to suggest evidence of serious pathology. Ultimately, an endoscopy revealed obstruction of her duodenum, and barium swallow identified compression by the superior mesenteric artery, leading to the diagnosis of superior mesenteric artery syndrome. She underwent a Roux-en-Y duodenojejunostomy. Six weeks later she continued to have severe left-sided pain and intermittent hematuria. Venography revealed compression of the left renal vein, extensive pelvic varices, and significant engorgement of her left ovarian vein. A diagnosis of nutcracker syndrome was made and a left renal vein transposition was performed. Significant improvement was seen after 8 weeks.ConclusionsThe disorders associated with aortomesenteric compression can lead to serious symptoms and sometimes death. Diagnosis is challenging not only because of the lack of awareness of these rare disorders, but also because they are associated with symptoms that are similar to those seen in less serious diseases. Guidance for health care professionals with respect to relevant radiological and clinical markers needs to be reconsidered in order to clarify the etiology of the diseases and create better diagnostic protocols.

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Nutcracker syndrome: A rare cause of left flank pain that can also manifest as unexplained pelvic pain

Cited by 25 publications

References 54 publications

Clinical and Radiological Significance of the Retroaortic Left Renal Vein

Clinical and Radiological Significance of the Retroaortic Left Renal Vein

Diagnóstico e tratamento da síndrome de quebra-nozes (nutcracker ): revisão dos últimos 10 anos

Co-occurring superior mesenteric artery syndrome and nutcracker syndrome requiring Roux-en-Y duodenojejunostomy and left renal vein transposition: a case report and review of the literature

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