Right nutcracker syndrome associated with left-sided inferior vena cava, hemiazygos continuation and persistant left superior vena cava: a rare combination

Yıldız, Attila; Çaycı, Fatma Şemsa; Genç, Sinan; Çakar, Nilgün; Fítöz, Suat

doi:10.1016/j.clinimag.2013.12.007

Cited by 9 publications

(9 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Nakazawa et al [ 21 ] noted compression of the left renal vein by dilated left-sided inferior vena cava. Other rare variants of NCS include right-sided NCS, which may be induced by pregnancy as a factor determining the compression of the right renal vein and the IVC [ 22 ] or by other anatomical variants like left-sided IVC [ 23 ].…”

Section: Definition and Types Of Ncsmentioning

confidence: 99%

What Each Clinical Anatomist Has to Know about Left Renal Vein Entrapment Syndrome (Nutcracker Syndrome): A Review of the Most Important Findings

Orczyk

Wysiadecki

Majos

et al. 2017

BioMed Research International

View full text Add to dashboard Cite

Nutcracker syndrome (NCS) is the most common term for compression of the left renal vein between the superior mesenteric artery and the abdominal aorta. The development of NCS is associated with the formation of the left renal vein (LRV) from the aortic collar during the sixth to eighth week of gestation and abnormal angulation of the superior mesenteric artery from the aorta. Collateralization of venous circulation is the most significant effect of NCS. It includes mainly the left gonadal vein and the communicating lumbar vein. Undiagnosed NCS may affect retroperitoneal surgery and other radiological and vascular procedures. The clinical symptoms of NCS may generally be described as renal presentation when symptoms like haematuria, left flank pain, and proteinuria occur, but urologic presentation is also possible. Radiological methods of confirming NCS include Doppler ultrasonography as a primary test, retrograde venography, which can measure the renocaval pressure gradient, computed tomography angiography, which is faster and less traumatic, intravascular ultrasound, and magnetic resonance angiography. Treatment can be conservative or surgical, depending on the severity of symptoms and degree of LRV occlusion. Nutcracker syndrome is worth considering especially in differential diagnosis of haematuria of unknown origin.

show abstract

Section: Definition and Types Of Ncsmentioning

confidence: 99%

What Each Clinical Anatomist Has to Know about Left Renal Vein Entrapment Syndrome (Nutcracker Syndrome): A Review of the Most Important Findings

Orczyk

Wysiadecki

Majos

et al. 2017

BioMed Research International

View full text Add to dashboard Cite

show abstract

“…Pregnancy is defining as a factor contributing to right-sided NCS by compression of large veins [1] . Left-sided IVC, hemiazygos continuation and persistent left superior vena cava combination is another rare cause of right NCS [4] . All of the anatomic mechanisms involved in renal vein compression are resulting with outflow obstruction leads to LRV hypertension with a measurable renocaval pressure gradient.…”

Section: Anatomical Configuration and Pathophysiologymentioning

confidence: 99%

Nutcracker syndrome

Gulleroglu

Gülleroğlu

Baskın

2014

WJN

117

160

View full text Add to dashboard Cite

The nutcracker phenomenon [left renal vein (LRV) entrapment syndrome] refers to compression of the LRV most commonly between abdominal aorta and superior mesenteric artery. Term of nutcracker syndrome (NCS) is used for patients with clinical symptoms associated with nutcracker anatomy. LRV entrapment divided into 2 types: anterior and posterior. Posterior and right-sided NCSs are rare conditions. The symptoms vary from asymptomatic hematuria to severe pelvic congestion. Symptoms include hematuria, orthostatic proteinuria, flank pain, abdominal pain, varicocele, dyspareunia, dysmenorrhea, fatigue and orthostatic intolerance. Existence of the clinical features constitutes a basis for the diagnosis. Several imaging methods such as Doppler ultrasonography, computed tomography angiography, magnetic resonance angiography and retrograde venography are used to diagnose NCS. The management of NCS depends upon the clinical presentation and the severity of the LRV hypertension. The treatment options are ranged from surveillance to nephrectomy. Treatment decision should be based on the severity of symptoms and their expected reversibility with regard to patient's age and the stage of the syndrome.

show abstract

“…The presence of a NCS caused by the compression of a left inferior vena cava by the SMA and aorta is extremely rare, having only been reported on three occasions 8. Individuals may present with abdominal pain or pelvic congestion syndrome (dyspareunia, dysmenorrhoea and chronic pelvic pain) as a result of the inflammatory cascade triggered by venous hypertension 9. Back pain radiating to the gluteal region has also been described.…”

Section: Discussionmentioning

confidence: 99%

Left renal vein entrapment syndrome: nutcracker syndrome!

Dunphy¹,

Penna

Tam

et al. 2019

BMJ Case Rep

View full text Add to dashboard Cite

Nutcracker syndrome (NCS) is a rare vascular compression disorder that involves compression of the left renal vein most commonly between the aorta and the superior mesenteric artery (SMA), although variations exist. It is associated with the formation of the left renal vein from the aortic collar during the 6th–8th week of gestation and abnormal angulation of the SMA from the aorta. Collateralisation of venous circulation including mainly the left gonadal vein and the communicating lumbar vein are the most significant effects. It has a female predilection occurring in the third to fourth decade and it tends to be diagnosed earlier in men. Affected individuals may present with a myriad of symptoms such as haematuria, left flank pain and proteinuria. As patients often present with these non-specific symptoms to primary care, knowledge of NCS is essential. The diagnosis can be rendered with Doppler ultrasonography, retrograde venography, CT angiography, intravascular ultrasound and magnetic resonance angiography. The authors describe the case of a 39-year-old woman with a low body mass index (BMI) presenting with generalised abdominal and flank pain as well as chronic microcytic anaemia. Physical examination findings were suggestive of biliary or renal colic. Laboratory investigations confirmed her anaemia (haemoglobin 88 g/L, mean corpuscular volume (MCV) 72 fL), but were otherwise unremarkable. Urinalysis showed proteinuria and haematuria. However, ultrasonography was unremarkable with a normal gallbladder and no evidence of calculi. Her CT scan showed marked compression of the left renal vein between the aorta and the SMA (nutcracker phenomenon), with upstream left renal, left gonadal and left lumbar vein dilatation. She was managed conservatively. This paper provides an overview of the aetiology, embryology, clinical manifestations, imaging modalities and management of NCS.

show abstract

Right nutcracker syndrome associated with left-sided inferior vena cava, hemiazygos continuation and persistant left superior vena cava: a rare combination

Cited by 9 publications

References 12 publications

What Each Clinical Anatomist Has to Know about Left Renal Vein Entrapment Syndrome (Nutcracker Syndrome): A Review of the Most Important Findings

What Each Clinical Anatomist Has to Know about Left Renal Vein Entrapment Syndrome (Nutcracker Syndrome): A Review of the Most Important Findings

Nutcracker syndrome

Left renal vein entrapment syndrome: nutcracker syndrome!

Contact Info

Product

Resources

About