Renal nutcracker syndrome genetic and rare diseases. The nutcracker phenomenon left renal vein lrv entrapment syndrome refers to compression of the lrv most commonly between abdominal aorta and superior mesenteric artery. Diagnosis of the nutcracker syndrome with color doppler. Nutcracker syndrome ncs 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. Doppler ultrasound, computed tomography ct and selective left renal vein phlebography are useful to. Nutcracker syndrome got its name because the compression of the renal vein is like a nutcracker cracking a nut. Baishideng publishing group inc, 7041 koll center parkway, suite 160, pleasanton, ca 94566, usa. 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. Doppler ultrasound measurements of the anteriorposterior ap diameter and peak velocities of the left renal vein may be helpful in diagnosing nutcracker syndrome. Transverse ultrasound image demonstrates compression of the left renal vein lrv between the superior mesenteric artery sma and aorta ao courtesy of ahmad alomari, md. The symptoms vary from asymptomatic hematuria to severe pelvic congestion.
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. Imaging findings and clinical features of abdominal vascular compression syndromes. Jun 22, 2017 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. Flow may be reduced in gastroduodenal artery and common hepatic artery. The purpose of this study was to evaluate the clinical characteristics of 44 pediatric patients who were diagnosed as having nutcracker syndrome ncs. Left renal vein transposition for nutcracker syndrome. The diagnosis of the nutcracker syndrome was suspected based on clinical examination, doppler scan, duplex ultrasound scan, computed tomography scan, and magnetic resonance imaging. Citeseerx document details isaac councill, lee giles, pradeep teregowda. The sensitivity and specificity of color doppler sonography for revealing the nutcracker syndrome were 78% and 100%, respectively, when color flow in collateral veins was included in the diagnostic criteria.
The peak velocity pv was measured at the hilar portion of the left renal vein. Indications of renal doppler ultrasound 3 authorstream. Other types of ncp are a combination of anterior nutcracker and compression of the third portion of duodenum. 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. Radiographic features are similar on ultrasound, doppler ultrasound, ct, mri, and. Doppler ultrasound, which uses the ultrasound waves in order to get pictures of the blood flowing through the veins, is conducted on the patient to check for the syndrome and confirm it. Doppler ultrasound showed left renal vein compression while 3 d computerized tomography angiography confirmed the diagnosis of. Nutcracker syndrome ncs is a rare entity defined by the symptomatic hypertension of the left renal vein lrv compressed in the majority of cases between the superior mesenteric artery and the aorta. Phlebolymphology is an international scientific journal entirely devoted to venous and lymphatic diseases. Term of nutcracker syndrome ncs is used for patients with clinical symptoms associated with nutcracker anatomy. The nutcracker syndrome is a rare vascular abnormality and the term was first used by grant 1 in anatomical description the left renal vein as it lies between the aorta and the superior mesenteric artery resembles a nut between the jaws of a nutcracker and was later used to describe a.
Nutcracker syndrome accompanying pelvic congestion syndrome. Nutcracker syndrome and pelvic congestion syndrome part 4 duration. 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. Diagnosed as both nutcracker ns and wilkie ws syndrome. Doppler ultrasound a common test that uses ultrasound waves to make pictures of the blood flowing through your veins. Indications of renal doppler ultrasound 3 nutcracker syndrome ratio of peak velocities cho bs et al. The type of nutcracker syndrome in this case report is known as anterior nutcracker 1,2. A rare and potentially under diagnosed cause of haematuria. Doppler ultrasound, computed tomography ct and selective left renal vein phlebography are useful to confirm. The diagnosis was confirmed by retrograde cinevideoangiography with renocaval gradient determination and catheterization of both internal iliac venous systems. The selection of the imaging modality is a stepwise process. Abstract to assess the detection rate of nutcracker syndrome in children with isolated hematuria, renal doppler ultrasound examinations were routinely performed on 216 consecutive children 176 microscopic hematuria and 40 gross hematuria. 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. Fitoz s, ekim m, ozcakar zb, elhan ah, yalcinkaya f, et al.
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. Doppler ultrasound showed left renal vein compression while 3 d computerized tomography angiography confirmed the diagnosis of an anterior nutcracker. Ultrasound imaging can often demonstrate the compressed renal vein and allow for measurement of the vein diameter and stenosis secondary to the compression fig. Abstract background nutcracker phenomenon ncp describes the compression of the left renal vein between the aorta and the superior. Oct 04, 2019 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. 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.
Clinically, nutcracker syndrome is characterized by intermittent hematuria with or without left flank or abdominal pain. Effect of renal doppler ultrasound on the detection of nutcracker syndrome in children. We also investigated the left renal vein doppler ultrasonography dus results, to determine whether or not there was an association between clinical symptoms and dus findings among these patients. Nutcracker syndrome ncs describes left renal vein compression between the superior mesenteric artery and the aorta. I have been told that i may have nutcracker syndrome as a. However, it is estimated to be relatively more common in females and usually presents in the 3rd or 4th decade of life. Terms in this set 69 nutcracker syndrome is the result of extrinsic compression of what.
Nutcracker syndrome is diagnosed through imaging such as doppler ultrasound dus, computed tomography ct, magnetic resonance imaging mri, and venography. The nutcracker syndrome can exist in either nondistended or distended left renal veins. Dus is the initial choice after clinical suspicion based on symptoms. The prevalence of nutcracker syndrome is relatively high in children with isolated hematuria, and the inclusion of renal doppler ultrasound as a screening examination has a substantial effect on. A case report of a young girl with recurrent hematuria. Several treatment options have been described to relieve associated symptoms. To confirm a nutcracker syndrome diagnosis, your doctor may order tests such as. We present a ten year old girl with four episodes of painless gross hematuria and recurrent microscopic hematuria since the age of two years. Numerous attempts have been made to improve doppler ultrasound diagnostic criteria. Mar 22, 2018 nutcracker syndrome ncs refers to the clinical manifestations of ncp.
The nutcracker syndrome is a anatomic abnormality of the kidney vessels such that the left kidney vein becomes partially blocked by the aorta the large blood vessel running in the middle of your i have been told that i may have nutcracker syndrome as a result of a doppler ultrasound. Imaging findings and clinical features of abdominal vascular. Doppler us findings in 16 patients with the nutcracker synd. Diagnostic value of renal doppler ultrasonography for detecting nutcracker syndrome in children with recurrent gross hematuria show all authors. Shin ji, park jm, lee js, kim mj 2007 effect of renal doppler ultrasound on the detection of nutcracker syndrome in children with hematuria. Nutcracker syndrome, vascular imaging with ultrasound longdom. Nutcracker syndrome doppler ultrasound diagnosis eurorad. Kirby sebro 1, lester goetz 1, satyendra persaud 2 1 division of surgical sciences, university of the west indies, st augustine, trinidad and tobago.
According to many authors, a ratio higher than 5 between the doppler ultrasound peak velocity of the narrow tract and the distended portion, is diagnostic, as well as the ratio be tween the diameter of the distended and the. Doppler ultrasound measurements of the anteriorposterior ap diameter and peak velocities of the left renal vein may be helpful in diagnosing. Some people may not have symptoms, while others develop severe and. Jan 06, 2017 nutcracker syndrome and pelvic congestion syndrome part 4 duration. Noninvasive ultrasound and crosssectional imaging can show the anatomic abnormality. The prevalence of nutcracker syndrome is relatively high in children with isolated hematuria, and the inclusion of renal doppler ultrasound as a screening examination has a substantial effect on the detection of nutcracker syndrome. Diagnostic value of renal doppler ultrasonography for. Imaging findings and clinical features of abdominal. Duplex ultrasound investigation in pelvic congestion syndrome. Svensson christina, department of medicine and health science. To assess the detection rate of nutcracker syndrome in children with isolated hematuria, renal doppler ultrasound examinations were routinely performed on 216 consecutive children 176 microscopic hematuria and 40 gross hematuria.
Nutcracker syndrome is a vascular compression disorder that refers to the. The degree of stenosis may be detected measuring doppler flow velocities by dus. Doppler us findings in 16 patients with the nutcracker syndrome and in 18 healthy control subjects were compared. Nutcracker syndrome wikimili, the free encyclopedia. The prevalence of nutcracker syndrome is relatively high in children with isolated hematuria, and the inclusion of renal doppler ultrasound as a.
This paper aims to provide education and ultrasound protocol for clinicians and sonographers who encounter patients with the symptoms of ncs during their course of practice. Doppler ultrasonography us has been commonly used for the diagnosis of ncs. Diagnosis of the nutcracker syndrome with color doppler sonography. 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. See more ideas about superior mesenteric artery, superior mesenteric artery syndrome and pelvic congestion syndrome. Color doppler sonography and multislice ct findings.
Oct 19, 2006 to assess the detection rate of nutcracker syndrome in children with isolated hematuria, renal doppler ultrasound examinations were routinely performed on 216 consecutive children 176 microscopic hematuria and 40 gross hematuria. Effect of renal doppler ultrasound on the detection of nutcracker. Sonographic evidence of nutcracker phenomenon, an incidental finding in a patient referred to investigate cholecystitis. The purpose of this study was to evaluate late results of lrv transposition and identify risk factors affecting outcomes. Original paper effect of renal doppler ultrasound on the. Examination in long axis using color doppler will reveal the presence of a velocity gradient from the perihilar to mesoaortic region 810. Feb 19, 2015 16 year old female patient, presenting with nausea, vomiting, abdominal pain and hematuria. Hematuria, pelvic or back pain and left varicocele are the most commonly symptoms. Pelvic congestion syndrome on doppler ultrasound youtube. 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. This can lead to renal venous hypertension, resulting in rupture of thinwalled veins into. Duplex ultrasound investigation in pelvic congestion. Nutcracker syndrome doppler ultrasound diagnosis section. Ultrasound at u of sc school of medicine 205,396 views.
There is a wide spectrum of clinical presentations and diagnostic criteria are not well defined, which frequently results in delayed or incorrect diagnosis. Patients with varicocele and nutcracker syndrome did not have a significant difference in either the hilar or amp diameter compared with patients with varicocele without nutcracker syndrome. The exact prevalence of nutcracker syndrome is unknown, likely because of the variable presenting features. Renal doppler ultrasound was also performed on 32 healthy normal children. The patient stated that he did not feel an ache in his scrotum and that his blood pressure was normal. To assess diagnosis of the nutcracker renal vein entrapment syndrome with doppler ultrasonography us. Philippe lemasle1 milka greiner2 1 cabinet nouvelle france, 15 rue pottier, 78150 le chesnay, france 2 american hospital of paris, vascular department, 63 bd victor hugo, 92200 neuilly sur seine, france abstract chronic pelvic venous insufficiency is a common pathology, but it is overlooked and underdiagnosed as it sits on the edge of two medical specialties. They had a significant difference in both the hilar and amp peak flow velocity p. Effect of renal doppler ultrasound on the detection of. The presence of increased flow within collateral vessels is further evidence of renal. The peak velocity pv was measured at the hilar portion of the left renal vein lrv and. Aims this paper aims to provide education and ultrasound protocol for clinicians and sonographers who encounter patients with the symptoms of ncs during their course of practice.