Nutcracker syndrome is a vascular compression disorder, and refers to compression of the left renal vein between the superior mesenteric artery and the aorta. I have found very little information on this syndrome. Symptoms of nutcracker syndromes may include intermittent left flank pain associated with hematuria, proteinuria, and sometimes with symptoms of pelvic congestion. Nov 06, 2014 the nutcracker phenomenon left renal vein lrv entrapment syndrome refers to compression of the lrv most commonly between abdominal aorta and superior mesenteric artery. Left renal vein lrv as it enters in the left kidney. This can result in elevated left renal vein pressure and reduced renal perfusion. Nutcracker syndrome ns refers to symptomatic compression of the left renal vein lrv between the abdominal aorta and superior mesenteric artery with potential symptoms including hematuria, proteinuria, left flank pain, and renal venous hypertension. Nutcracker syndrome is one of the abdominal venous entrapments, caused by compression of the left renal vein between the superior mesenteric artery and the abdominal aorta. Nutcracker syndrome symptoms, treatment, causes, surgery. Left renal vein entrapment syndrome, characterized by the compression of the left renal vein lrv between the superior mesenteric artery sma and the abdominal aorta was first described in 1950. The nutcracker syndrome is a vascular disorder, but the signs and symptoms are mainly urological or gynecological.
I dont know whats going in but they said not to worry about the renal vein unless my red blood cells are low or peeing out blood life is getting hard. She was diagnosed in april 2009 after over a year and a half of trying to figure out what was wrong. 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. Decreased urine output or kidney function may be the only observable symptoms caused by a blood clot renal vein. Kirby sebro 1, lester goetz 1, satyendra persaud 2 1 division of surgical sciences, university of the west indies, st augustine, trinidad and tobago. Nutcracker syndrome, which refers to symptoms associated with the above. Nutcracker syndrome ncs is caused by compression of left renal vein lrv, usually between the aorta and the superior mesenteric artery sma. Nutcracker syndrome is caused by stenosis of the left renal vein lrv as it passes anteriorly to the aorta through the fork formed by both abdominal aorta aa and superior mesenteric artery sma. Nutcracker syndrome can be treated, and treatments depend on your age, anatomy, and symptoms.
Nutcracker syndrome is caused by compression of the left renal vein between the aorta and the superior mesenteric artery where it passes in the fork formed at the bifurcation of these arteries. Dus is the initial choice after clinical suspicion based on symptoms. Renal nutcracker syndrome symptoms, diagnosis, treatments. Renal vein stenting for nutcracker syndrome endovascular. Nutcracker syndrome is a condition where there is compression of the left renal vein between the aorta and the superior mesenteric artery causing symptoms.
The signs and symptoms of ncs are all derived from the outflow obstruction of the left renal vein. The name nutcracker syndrome comes from the image of the left renal vein being compressed, or cracked, between the aorta and superior mesenteric arteries. The phenomenon results in left renal venous hypertension. Nutcracker syndrome is also sometimes called posterior nutcracker phenomenon and wilkie syndrome.
Nutcracker syndrome, also called renal nutcracker syndrome is a rare vascular condition. Nutcracker phenomenon and nutcracker syndrome mayo clinic. The nutcracker syndrome is characterized by entrapment and compression of the left renal vein between the abdominal aorta and the superior mesenteric artery sma figure 1. Multidetector ct of vascular compression syndromes in the. I dont know whats going in but they said not to worry about the renal vein unless my red blood cells are low or. The clinical symptoms of ncs may generally be described as renal. In some cases, nutcracker syndrome may not need treatment, especially for patients who are. The nutcracker syndrome ncs is the clinical equivalent of. Nutcracker syndrome treatment nutcracker syndrome treatments can vary based on your age, symptoms, and the severity of your condition. We describe the diagnosis and management of nine patients studied in our institutions. This syndrome causes impaired blood flow, along with swelling of the distal area of the vein.
Nutcracker syndrome is caused by compression of the left renal vein between the. My main symptoms are left flank pain and unexplained hematuria. Importance symptoms of nutcracker syndrome are complex and include left flank and abdominal pain, macroscopic or microscopic hematuria, left renal togonadal vein reflux resulting in pelvic congestion syndrome in females, varicoceles in males, orthostatic proteinuria, lower limb varices, and chronic fatigue symptoms. Aug 25, 2016 renal vein entrapment the nutcracker syndrome. Private group for those diagnosed with nutcracker syndrome or renal vein stenosis, and or other vascular compression disorders. Nov 09, 2016 nutcracker syndrome can be treated, and treatments depend on your age, anatomy, and symptoms. This is a safe private space for information, discussion and above all. Nutcracker syndrome gets its name because this compression is like a nutcracker crushing a nut. The nutcracker syndrome left renal vein entrapment, demonstrated by ultrasonic imaging and doppler flow scanning renal manifestations of sickle cell disease view in chinese hematuria has been attributed to the greater length of the left renal vein and the nutcracker phenomenon, in which compression of the left renal vein between. The term ncs is used for patients with nutcracker anatomy who present with the characteristic clinical symptoms such as hematuria, proteinuria. A rare and potentially under diagnosed cause of haematuria. Nutcracker syndrome ncs, which is caused by compression of the left renal vein between the abdominal aorta and the superior mesenteric artery, leads to a series of clinical symptoms including. Left renal vein entrapment syndrome, known clinically as nutcracker syndrome, is an uncommon constellation of vessels resulting in increased blood pressure before compression.
Although often asymptomatic, this condition may occur with haematuria more frequently microhaematuria, flank or abdominal pain. They said my colon doesnt function properly so thats what they think is causing it but i also have a compressed renal vein which can cause nutcracker syndrome. It occurs when arteries compress the left renal kidney vein, often causing intermittent hematuria blood in the urine. Left renal vein transposition is an efficient surgical treatment for nutcracker syndrome. My doctor is working with the mayo clinic in minnesota, where i will hopefully have surgery to fix this very painful issue. Despite potential serious consequences, diagnosing ncs is often challenging, circuitous and commonly delayed.
I was diagnosed with posterior nutcracker syndrome last week. Nutcracker syndrome ncs refers to the clinical manifestations of ncp. Renal nutcracker syndrome information including symptoms, diagnosis, misdiagnosis, treatment, causes, patient stories, videos, forums, prevention, and prognosis. In nutcracker syndrome, symptoms are most often caused when the left renal vein coming from the left kidney becomes compressed and blood cant flow normally through it. The mild nutcracker syndrome can be witnessed in children during the changes their body undergoes due to growth. The reason why this happens is a medical mystery but it is believed that abnormal organogenesis during fetal life is the. A rare, syndromic renal disease characterized by the entrapment of left renal vein lrv between the superior mesenteric artery sma and. Furthermore, signs and symptoms of renal nutcracker syndrome may vary on an individual basis for each patient. I would like to find anyone that has been diagnosed with the nutcracker syndrome. At the upmc heart and vascular institute, our surgeons in the division of vascular surgery are experts in treating nutcracker syndrome. However, obstruction of the gonadal outflow may produce similar symptoms.
The syndrome is manifested by left flank and abdominal pain, with or without unilateral. This can lead to obstruction of flow into the inferior vena cava and secondary left renal venous hypertension. The underlying anatomic anomaly, first described by gant in 1937, can lead to left renal venous. Nutcracker syndrome is a vascular compression disorder that refers to the compression of the left renal vein most commonly between the superior mesenteric artery sma and aorta, although other variations can exist 1 this can lead to renal venous hypertension, resulting in rupture of thinwalled veins into the collecting system with resultant hematuria. The nutcracker syndrome or nutcracker phenomenon is, basically, the compression of the left renal vein, usually between the superior mesenteric artery and the aorta. What each clinical anatomist has to know about left renal. Other less common causes include hypercoagulable state, invasion by renal cell carcinoma, kidney transplantation, behcet syndrome, antiphospholipid antibody syndrome or blunt trauma to the back or abdomen. This signs and symptoms information for renal nutcracker syndrome has been gathered from various sources, may not be fully accurate, and may not be the full list of renal nutcracker syndrome signs or renal nutcracker syndrome symptoms. It results most commonly from the compression of the left renal vein between the abdominal aorta and superior mesenteric artery. Symptoms of ncs include haematuria, thought to be caused by extravasation of blood due to increased venous pressure from the stenosis of the lrv. It is characterized by left renal vein entrapment between the abdominal aorta and the superior mesenteric artery causing renal venous hypertension. Renal nutcracker syndrome symptoms, diagnosis, treatments and. Renal vein entrapment the nutcracker syndrome brandon t.
Renal vein stenting for nutcracker syndrome endovascular today. The nutcracker phenomenon left renal vein lrv entrapment syndrome refers to compression of the lrv most commonly between abdominal aorta and superior mesenteric artery. Renal vein entrapment, or more commonly nutcracker syndrome, is a phenomenon occurs when there is an obstruction somewhere along the left renal vein that prevents the circulation from passing through unopposed into the inferior vena cava and eventually, b. Kidney autotransplant surgery is successful at making the pain go away and relieving the symptoms of nutcracker syndrome without disrupting kidney function affecting how your kidneys work inside your body. It is associated with the formation of the left renal. Nutcracker syndrome servier phlebolymphologyservier. Nutcracker syndrome got its name because the compression of the renal vein is like a nutcracker cracking a nut. Meissner the nutcracker syndrome is characterized by entrapment and compression of the left renal vein between the abdominal aorta and the superior mesenteric artery sma figure 1. Renal nutcracker syndrome is a condition where the left renal vein is compressed by the abdominal aorta and the superior mesenteric artery. However, the exact incidence of the symptomatic nutcracker syndrome is not. Renal vein entrapment, or more commonly nutcracker syndrome, is a phenomenon occurs when there is an obstruction somewhere along the left renal vein that prevents the circulation from passing through unopposed into the inferior vena cava and eventually, back to the heart.
We finally went to mayo clinic and she was diagnosed there. 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. Nutcracker syndrome is a variation of nutcracker phenomenon or renal vein entrapment syndrome, in which the arteries near the kidney compress the left renal kidney vein. Degree of left renal vein compression predicts nutcracker. A case report of a young girl with recurrent hematuria. Renal nutcracker syndrome ncs is a condition that occurs when the left renal vein the vein that carries blood purified by the left kidney becomes compressed. The symptoms and severity of renal nutcracker syndrome can vary from person to person. Nutcracker 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. Symptoms usually dont become obvious until the third or fourth decade. Surgical options, abstract nutcracker syndrome is one of the abdominal venous entrapments, caused by compression of the left renal vein between the superior mesenteric artery and the abdominal aorta. Symptoms of nutcracker syndrome include hematuria blood in the urine, left flank pain, left lower quadrant pain in women and left testicular swelling or pain in men. Other symptoms associated with nutcracker syndrome include orthostatic proteinuria, flank pain, leftsided varicocele, pelvic congestion, and chronic fatigue.
It took months to get this diagnosis, along with multiple hospital stays. In nutcracker syndrome, symptoms are most often caused when the left renal vein coming from the left kidney becomes compressed and blood. She had surgery, which is left renal vein transposition, where her symptoms. Nutcracker syndrome is a vascular compression disorder that refers to the compression of the left renal vein most commonly between the superior mesenteric artery sma and aorta, although other variations can exist 1. A rare condition where the left renal vein becomes compressed between the abdominal aorta and the superior mesenteric artery. She had surgery, which is left renal vein transposition, where her symptoms resolved for about two weeks. Left renal vein entrapment syndrome nutcracker syndrome. Nutcracker syndrome encompasses classical symptoms of hematuria and flank pain resulting from the compression of the left renal vein between the aorta and the superior mesenteric artery. Treatment of nutcracker syndrome florida surgical clinic. It may form collateral vascularization, resulting in diverse clinical symptoms. Common signs and symptoms when the condition shows no symptoms. Aug 04, 2011 they said my colon doesnt function properly so thats what they think is causing it but i also have a compressed renal vein which can cause nutcracker syndrome.
Current trends in the diagnosis and management of renal. My daughter has nutcracker syndrome testicular disorders. Nutcracker syndrome is an easily missed cause of hematuria in children. Normally, the left renal vein brings blood out of the left kidney and. It is due to the compression of the distal segment of the left renal vein lrv between the superior mesenteric artery sma and the aorta also called left renal vein entrapment. Intermittent hematuria and orthostatic proteinuria with or without abdominal or flank pain are the common clinical manifestations. The posterior nutcracker syndrome is very rare and is considered when the left renal vein is compressed between the aorta and vertebral column. Some people may not have symptoms, while others develop severe and persistent symptoms.
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. Pdf left renal vein entrapment syndrome nutcracker. Following are the common symptoms that have been studied in the nutcracker syndrome. Mesoaortic compression of the left renal vein nutcracker syndrome produces both obstruction and reflux, resulting in symptoms of pelvic congestion. Diagnosis and surgical treatment of nutcracker syndrome.
Nutcracker syndrome, which refers to symptoms associated with the above phenomenon, usually presents with acute onset hematuria and abdominal pain, but more rarely, may present as chronic fatigue syndrome. Mar 22, 2018 nutcracker syndrome ncs refers to the clinical manifestations of ncp. The symptoms vary from asymptomatic hematuria to severe pelvic congestion. Term of nutcracker syndrome ncs is used for patients with clinical symptoms associated with nutcracker anatomy. Renal nutcracker syndrome genetic and rare diseases nih. Clinically, nutcracker syndrome is characterized by intermittent hematuria with or without left flank or abdominal pain. Nutcracker phenomenon refers to compression of the left renal vein, most commonly. Nutcracker syndrome is a constellation of symptoms resulting from renal vein entrapment or mesoaortic compression of the left renal vein. In some cases however pelvic pain remains following left renal vein transposition. 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. In most cases, compression of the left renal vein is between the abdominal aorta the main artery in the abdomen and the superior mesenteric artery, which brings blood. No consensus diagnostic criteria exist to guide endovascular treatment.
Renal nutcracker syndrome genetic and rare diseases. 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. Nutcracker syndrome is diagnosed through imaging such as doppler ultrasound dus, computed tomography ct, magnetic resonance imaging mri, and venography. The selection of the imaging modality is a stepwise process. Occasionally a retroaortic left renal vein is compressed between the aorta and the vertebral body posterior nutcracker syndrome. Entrapment of the left renal vein lrv between the abdominal aorta and superior mesenteric artery sma causing the classic clinical triad of hematuria, varicocele, and left abdominal or flank pain was first described in 1950.