2021
DOI: 10.1016/j.radcr.2021.05.007
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Nutcracker syndrome: A rare cause of chronic pelvic pain and left back pain

Abstract: The Nutcracker Syndrome is a rare and often unrecognized cause of chronic pelvic pain and left back pain. These symptoms are due to the left renal vein compression between the aorta and the superior mesenteric artery (anterior nutcracker) or between the aorta and the spine (posterior nutcracker). The variety of clinical manifestations make the diagnosis difficult and commonly delayed. Therefore, imaging plays a key role in correcting the diagnosis by confirming the left renal vein stenosis and ruling out any d… Show more

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Cited by 4 publications
(9 citation statements)
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“…NCS diagnosis is confirmed mainly by image evaluation, but no unified diagnostic standard exists [ 1 , 2 , 11 ]. CT and Doppler ultrasonography are the imaging methods most commonly used for diagnosis; the diagnostic criteria are the distance between the SMA and abdominal aorta and the beak sign in axial images, and the angle between SMA and abdominal aorta in sagittal images [ 1 , 4 , 11 , 12 ]. Another method of diagnosis is to measure the blood pressure gap between the IVC and LRV, but this method is invasive and uncommon [ 1 , 2 , 4 , 12 ].…”
Section: Discussionmentioning
confidence: 99%
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“…NCS diagnosis is confirmed mainly by image evaluation, but no unified diagnostic standard exists [ 1 , 2 , 11 ]. CT and Doppler ultrasonography are the imaging methods most commonly used for diagnosis; the diagnostic criteria are the distance between the SMA and abdominal aorta and the beak sign in axial images, and the angle between SMA and abdominal aorta in sagittal images [ 1 , 4 , 11 , 12 ]. Another method of diagnosis is to measure the blood pressure gap between the IVC and LRV, but this method is invasive and uncommon [ 1 , 2 , 4 , 12 ].…”
Section: Discussionmentioning
confidence: 99%
“…CT and Doppler ultrasonography are the imaging methods most commonly used for diagnosis; the diagnostic criteria are the distance between the SMA and abdominal aorta and the beak sign in axial images, and the angle between SMA and abdominal aorta in sagittal images [ 1 , 4 , 11 , 12 ]. Another method of diagnosis is to measure the blood pressure gap between the IVC and LRV, but this method is invasive and uncommon [ 1 , 2 , 4 , 12 ]. In this case, we diagnosed NCS because the CT images showed clear LRV stenosis and because venography confirmed regurgitation from the LRV to LOV.…”
Section: Discussionmentioning
confidence: 99%
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“…1,3 NCS results from compression of the left renal vein (LRV) between the aorta and the superior mesenteric artery (SMA), or between the aorta and the spine, resulting in LRV compression and development of collateral veins. 4,5 The main symptoms are flank (loin) or abdominal pain, haematuria, and pelvic congestion. The severity of symptoms guides the clinical management.…”
Section: Introductionmentioning
confidence: 99%
“…Other indications for performing a RAT are rare conditions such as loin pain haematuria syndrome (LPHS), and the nutcracker syndrome (NCS), especially when other treatments have failed 1,3 . NCS results from compression of the left renal vein (LRV) between the aorta and the superior mesenteric artery (SMA), or between the aorta and the spine, resulting in LRV compression and development of collateral veins 4,5 . The main symptoms are flank (loin) or abdominal pain, haematuria, and pelvic congestion.…”
Section: Introductionmentioning
confidence: 99%