NUT CRACKER SYNDROME
In medicine, the nutcracker syndrome (NCS) — is a clinically manifest variant of nutcracker phenomenon, renal vein entrapment syndrome, or mesoaortic compression of the left renal vein.
It results most commonly from the compression of the left renal vein between the abdominal aorta (AA) and superior mesenteric artery(SMA), although other variants exist.
The name derives from the fact that, in the sagittal plane and/or transverse plane, the SMA and AA (with some imagination) appear to be a nutcracker crushing a nut (the renal vein).
There is a wide spectrum of clinical presentations and diagnostic criteria are not well defined, which frequently results in delayed or incorrect diagnosis.
This condition is not to be confused with superior mesenteric artery syndrome, which is the compression of the third portion of the duodenum by the SMA and the AA.
Signs and symptoms
NCS is associated with hematuria (which can lead to anemia) and abdominal pain (classically left flank or pelvic pain).
Since the left gonad drains via the left renal vein it can also result in left testicularvaricocele and pain in men or left lower quadrant pain in women. Nausea andvomiting can result due to compression of the splanchnic veins.
NCS can also lead to varicocele formation and varicose veins in the lower limbs.
Another clinical study has shown that nutcracker syndrome is a frequent finding in varicocele-affected patients and possibly, nutcracker syndrome should be routinely excluded as a possible cause of varicocele and pelvic congestion.
Diagnosis
Nutcracker syndrome can be diagnosed with:
Left renal venography — considered to be the gold standard test.Computed tomography (CT).
Abdominal ultrasonography — not definitive but has been found to be useful.
Differential diagnosis
Pelvic Congestion Syndrome Renal stones Genitourinary malignancy Loin pain hematuria syndrome
Treatment
Treatment depends on the severity and symptoms. Treatments include:
Endovascular stenting.
Renal vein re-implantation Gonadal vein embolization.
Natural treatments such as yoga
In medicine, the nutcracker syndrome (NCS) — is a clinically manifest variant of nutcracker phenomenon, renal vein entrapment syndrome, or mesoaortic compression of the left renal vein.
It results most commonly from the compression of the left renal vein between the abdominal aorta (AA) and superior mesenteric artery(SMA), although other variants exist.
The name derives from the fact that, in the sagittal plane and/or transverse plane, the SMA and AA (with some imagination) appear to be a nutcracker crushing a nut (the renal vein).
There is a wide spectrum of clinical presentations and diagnostic criteria are not well defined, which frequently results in delayed or incorrect diagnosis.
This condition is not to be confused with superior mesenteric artery syndrome, which is the compression of the third portion of the duodenum by the SMA and the AA.
Signs and symptoms
NCS is associated with hematuria (which can lead to anemia) and abdominal pain (classically left flank or pelvic pain).
Since the left gonad drains via the left renal vein it can also result in left testicularvaricocele and pain in men or left lower quadrant pain in women. Nausea andvomiting can result due to compression of the splanchnic veins.
NCS can also lead to varicocele formation and varicose veins in the lower limbs.
Another clinical study has shown that nutcracker syndrome is a frequent finding in varicocele-affected patients and possibly, nutcracker syndrome should be routinely excluded as a possible cause of varicocele and pelvic congestion.
Diagnosis
Nutcracker syndrome can be diagnosed with:
Left renal venography — considered to be the gold standard test.Computed tomography (CT).
Abdominal ultrasonography — not definitive but has been found to be useful.
Differential diagnosis
Pelvic Congestion Syndrome Renal stones Genitourinary malignancy Loin pain hematuria syndrome
Treatment
Treatment depends on the severity and symptoms. Treatments include:
Endovascular stenting.
Renal vein re-implantation Gonadal vein embolization.
Natural treatments such as yoga
