Maythurner syndrome is caused by the right iliac artery being on top of and putting pressure on the left iliac vein in your pelvis. If they suspect nutcracker syndrome, your doctor will take urine samples to look for blood, protein, and bacteria. In patients with haematuria from the left kidney, angiographic ct must be considered before phlebography and pressure measurement of the left renal vein. The diagnosis of ncs requires a high index of suspicion and is often made by. When the kidney vein goes in front of the aorta, it may be pinched by the intestinal artery sma superior mesenteric artery anterior nutcracker syndrome. The symptoms are complex due to its similarity with other urologic and gynecologic disorders.
Superior mesenteric artery syndrome anyone heard of this. Blog nutcracker syndrome milford vascular institute. When checking for a misdiagnosis of renal nutcracker syndrome or confirming a diagnosis of renal nutcracker syndrome, it is useful to consider what other medical conditions might be possible misdiagnoses or other alternative conditions relevant to diagnosis. Diagnosis of nutcracker syndrome was suspected by doppler ultrasonography and then confirmed by magnetic resonance angiography performed with administration of bloodpool paramagnetic contrast medium. The ct findings are consistent with nutcracker syndrome. Developed by renowned radiologists in each specialty, statdx provides comprehensive decision support you can rely on nutcracker syndrome.
On rare occasions the kidney vein will go behind the aorta. Diagnosis of this syndrome requires a high index of suspicion and can be accomplished with duplex sonography, ct, magnetic resonance imaging, or venography, and it is confirmed by measured. My nephrologist believes i may have nutcracker syndrome. Nutcracker syndrome describes an array of incapacitating symptoms caused by lrv hypertension secondary to vein compression between the sma and the aorta. However, multiphase ct urography has the ability to reveal other causes of hematuria. To diagnose nutcracker syndrome, your upmc doctor will. Nutcracker syndrome can be difficult to diagnose because its symptoms are similar to many other urological and gynecological disorders. 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.
We finally went to mayo clinic and she was diagnosed there. Nutcracker syndrome, caused by compression of the left renal vein lrv between the superior mesenteric artery and the aorta, results in left renal and gonadal venous hypertension. Nutcracker syndrome can be challenging to diagnose because its symptoms can be like other urologic or gynecologic disorders. Conservative, open and endovascular options exist for treatment, however patient treatment must be individualized. There are a variety of ways but the most common are by ct scan, mra with contrast mri of veins, venogram and ivus with pressure testing and. Nutcracker phenomenon and nutcracker syndrome ncbi. Nutcracker syndrome ncs describes left renal vein compression between the superior mesenteric artery and the aorta.
Multidetector ct or mr imaging performed in the venous phase. Doppler us and ct diagnosis of nutcracker syndrome ncbi. Chronic pelvic pain is a very common problem among american women, accounting for 10 to 15% of referrals to gynecologists. Depending on specific manifestations, ncs may be encountered by different medical specialists. The left kidney vein has to cross over the left sided aorta to get to the right sided vena cava. Although uncommon, it is an important diagnosis due to the important morbidity associated with it, including the risk of chronic kidney disease from longterm left renal vein lrv hypertension and the risk of lrv thrombosis. Youve been diagnosed with pelvic congestion syndrome. The diagnosis of nutcracker syndrome is particularly difficult because it tends to present similarly to gynecologic or urinary issues. To assess diagnosis of the nutcracker renal vein entrapment syndrome with doppler ultrasonography us.
Nutcracker phenomenon ncp, also known as left renal vein entrapment, 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. Imaging findings and clinical features of abdominal vascular. Superior mesenteric artery syndrome presenting with acute massive gastric dilatation, gastric wall pneumatosis, and portal venous gas. Pdf nutcracker syndrome diagnosed with 3dimensional.
Doctors often diagnose nutcracker syndrome after ruling out other conditions. Multidetector ct of vascular compression syndromes in the. We report a case of nutcracker syndrome diagnosed with 3dimensional computed tomography angiography 3d cta. Blood samples can be used to check blood cell counts and kidney function. A high index of suspicion is required so that appropriate imaging may be requested. Left renal vein entrapment syndrome, also known as nutcracker syndrome, involves compression of the left renal vein and can present with abdominopelvic pain, hematuria, and symptoms of pelvic congestion syndrome. The term nutcracker syndrome ns refers to symptoms that arise from the nutcracker phenomenon. Nutcracker syndrome ncs is a rare condition characterized by entrapment of the left renal vein. I had another ct scan with barium and contrast dye. Which specialists are essential to meet, what tests are needed and other useful information for the diagnosis of nutcracker syndrome. Diagnosis and surgical treatment of nutcracker syndrome.
Management and diagnosis of nutcracker syndromea case. It is associated with the formation of the left renal vein from the aortic collar during the 6th8th week of gestation and abnormal angulation of the sma from the aorta. Nutcracker syndrome refers to the compression of the left renal vein between the aorta and the superior mesenteric artery, which results in elevated left renal vein pressure and possible collateral vein development. Nutcracker syndrome is a vascular compression disorder that refers to the compression of the left renal vein most commonly between the superior mesenteric. She was diagnosed in april 2009 after over a year and a half of trying to figure out what was wrong. Sometimes these terms are used interchangeably, but it has been emphasized 1 that the term nutcracker syndrome should be reserved for patients with the characteristic clinical symptoms in association with demonstrable radiographic findings. Nutcracker syndrome is a rare diagnosis and may manifest in unusual ways. Symptoms include blood in the urine along with flank and abdominal pain. Doppler ultrasonography us has been commonly used for the diagnosis of ncs. Computerized tomography ct was used to compare the anatomical relations of the left renal vein with the aorta and the superior mesenteric artery in three patients with the nutcracker syndrome. Renal vein stenting for nutcracker syndrome endovascular. Several treatment options have been described to relieve associated symptoms. I had a ct scan with contrast dye and my kidneys looked great. When symptomatic, such compressions can result in a variety of uncommon syndromes in the abdomen and pelvis, including median arcuate ligament syndrome mals, maythurner syndrome, nutcracker syndrome, superior mesenteric artery sma syndrome, upj obstruction, ovarian vein syndrome ovs, and other forms of ureteral compression.
In this article, we refer to this heterogeneous group of. Ive done some research on the internet, and it says people get the nutcracker syndrome because of untre. Individuals with ncs may also experience pelvic congestion causing various pelvic symptoms. The purpose of this study was to evaluate late results of lrv transposition and identify risk factors affecting outcomes. We report the case of a 16 year old male with an incidental finding of proteinuria. Nutcracker syndrome refers to the compression of the left renal vein. Renal nutcracker syndrome genetic and rare diseases. These alternate diagnoses of renal nutcracker syndrome may already have been considered. Doppler us findings in 16 patients with the nutcracker syndrome and in 18 healthy control subjects were compared. Apparently i have superior mesenteric artery syndrome. We explain the underlying pathophysiology that results in these clinical syndromes so that the patient subset who. The definitive diagnostic test for nutcracker syndrome.
Nutcracker syndrome ncs is a syndrome caused by compression of the left renal vein lrv, between the abdominal aorta and the superior. An even smaller percentage of that number will end up with the diagnosis of pelvic congestion syndrome. To reach a definitive diagnosis of this syndrome, the patient must undergo a ct scan or mri. The diagnosis of ncs is confirmed on imaging results, including dus, ct, magnetic resonance imaging mri, phlebography, and. Pelvic congestion syndrome pcs isnt a common condition, for sure. Diagnosis of the nutcracker syndrome with color doppler sonography.
The nutcracker syndrome ncs is the clinical equivalent of nutcracker phenomenon characterized by a complex of symptoms with substantial variations. Clinically, nutcracker syndrome is characterized by intermittent hematuria with or without left flank or abdominal pain. Furthermore, signs and symptoms of renal nutcracker syndrome may vary on an individual basis for each patient. If the diagnosis of the nutcracker syndrome is established, autotransplantation of the left kidney is a treatment alternative. Once other conditions have been ruled out, your vascular surgeon may recommend imaging tests, like an ultrasound, ct scan, or mri to screen for nutcracker syndrome. In some cases, more commonly in children, it can resolve spontaneously. Its common clinical presentation is intermittent microscopic hematuria, repeated attack of gross hematuria as well as left loin pain as in the presentation of this case.
The following report examines two case studies where a diagnosis of ncp was made from clinical history and ultrasound findings. If 2nd ct scan does not show anything definitive, my doctor will do a venogram. Nutcracker syndrome had been confirmed by conventional venography until recent years. Nowadays, with the development of imaging techniques, color doppler sonogram and 3d cta are replacing venography for the diagnosis of nutcracker. Nutcracker syndrome ncs is a syndrome caused by compression of the left renal vein lrv, between the abdominal aorta and the superior mesenteric artery, resulting in hypertension of the lrv and hematuria. Differentiation should be made between asymptomatic dilatation of the left renal vein nutcracker phenomenon and symptomatic patients nutcracker syndrome. This disease can occur anytime during a persons life but the highest incidence of this disease can be found in adults in their 20s30s. Only your doctor can provide adequate diagnosis of any signs or symptoms and whether they are indeed renal nutcracker syndrome symptoms. Nutcracker syndrome ncs, also known as left renal vein lrv entrapment syndrome is a condition that leads to stenosis of the aortomesenteric region of the lrv. My daughter has nutcracker syndrome testicular disorders.
Nutcracker syndrome was suspected based on the combination of clinical examination, ultrasound, ct imaging, and mri imaging. The diagnosis of nutcracker syndrome is often difficult and is commonly delayed. The syndrome is often diagnosed when other conditions are. Superior mesenteric artery syndrome combined with renal nutcracker syndrome in a young male.
I have celiac disease and i am on a completely gluten free diet. She had surgery, which is left renal vein transposition, where her symptoms. Imaging findings and clinical features of abdominal. Hematuria was the most common presenting symptom 21 of 23 patients. The usual course of renal nutcracker syndrome ncs is not clear and it remains underdiagnosed because symptoms vary from person to person. This article describes the typical imaging findings and clinical features that are associated with four abdominal vascular compression syndromes. Left renal vein transposition for nutcracker syndrome. In order to make an accurate diagnosis, the most important thing for a physician to be aware of the symptoms that can be present when a patient first shows manifestations of nutcracker syndrome.
505 361 305 962 968 544 1154 1016 289 1412 32 1202 1147 1421 222 761 932 782 1241 1479 398 91 270 1036 770 910 1176 1539 91 679 1544 1485 735 1548 1420 1460 1187 1073 324 1284 1449 1459 1072 701 960 1020 413