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KEY FACTS
Terminology
Imaging
Pathology
Clinical Issues
TERMINOLOGY
Definitions
Compression of left renal vein between aorta and superior mesenteric artery (SMA)
Causes left renal venous outflow obstruction
Results in left renal venous hypertension
May have accompanying hematuria
May have engorged edematous left kidney with intrarenal/perirenal varices
Secondary pelvic congestion syndrome may occur
Due to retrograde flow in left gonadal vein
IMAGING
General Features
Imaging Recommendations
Ultrasonographic Findings
CT Findings
MR Findings
Angiographic Findings
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Wang X et al: Results of endovascular treatment for patients with nutcracker syndrome. J Vasc Surg. 56(1):142-8, 2012
Chen S et al: Endovascular stenting for treatment of Nutcracker syndrome: report of 61 cases with long-term followup. J Urol. 186(2):570-5, 2011
Fitoz S et al: Nutcracker syndrome in children: the role of upright position examination and superior mesenteric artery angle measurement in the diagnosis. J Ultrasound Med. 26(5):573-80, 2007
Scholbach T: From the nutcracker-phenomenon of the left renal vein to the midline congestion syndrome as a cause of migraine, headache, back and abdominal pain and functional disorders of pelvic organs. Med Hypotheses. 68(6):1318-27, 2007
Shin JI et al: Doppler ultrasonographic indices in diagnosing nutcracker syndrome in children. Pediatr Nephrol. 22(3):409-13, 2007
Zhang H et al: The left renal entrapment syndrome: diagnosis and treatment. Ann Vasc Surg. 21(2):198-203, 2007
Ahmed K et al: Current trends in the diagnosis and management of renal nutcracker syndrome: a review. Eur J Vasc Endovasc Surg. 31(4):410-6, 2006
Culafic D et al: Spontaneous splenorenal shunt in a patient with liver cirrhosis and hypertrophic caudal lobe. J Gastrointestin Liver Dis. 15(3):289-92, 2006
Rudloff U et al: Mesoaortic compression of the left renal vein (nutcracker syndrome): case reports and review of the literature. Ann Vasc Surg. 20(1):120-9, 2006
Chang CT et al: Nutcracker syndrome and left unilateral haematuria. Nephrol Dial Transplant. 20(2):460-1, 2005
Cuellar i Calabria H et al: Nutcracker or left renal vein compression phenomenon: multidetector computed tomography findings and clinical significance. Eur Radiol. 15(8):1745-51, 2005
Kim SJ et al: Long-term follow-up after endovascular stent placement for treatment of nutcracker syndrome. J Vasc Interv Radiol. 16(3):428-31, 2005
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Pathology
Clinical Issues
TERMINOLOGY
Definitions
Compression of left renal vein between aorta and superior mesenteric artery (SMA)
Causes left renal venous outflow obstruction
Results in left renal venous hypertension
May have accompanying hematuria
May have engorged edematous left kidney with intrarenal/perirenal varices
Secondary pelvic congestion syndrome may occur
Due to retrograde flow in left gonadal vein
IMAGING
General Features
Imaging Recommendations
Ultrasonographic Findings
CT Findings
MR Findings
Angiographic Findings
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Wang X et al: Results of endovascular treatment for patients with nutcracker syndrome. J Vasc Surg. 56(1):142-8, 2012
Chen S et al: Endovascular stenting for treatment of Nutcracker syndrome: report of 61 cases with long-term followup. J Urol. 186(2):570-5, 2011
Fitoz S et al: Nutcracker syndrome in children: the role of upright position examination and superior mesenteric artery angle measurement in the diagnosis. J Ultrasound Med. 26(5):573-80, 2007
Scholbach T: From the nutcracker-phenomenon of the left renal vein to the midline congestion syndrome as a cause of migraine, headache, back and abdominal pain and functional disorders of pelvic organs. Med Hypotheses. 68(6):1318-27, 2007
Shin JI et al: Doppler ultrasonographic indices in diagnosing nutcracker syndrome in children. Pediatr Nephrol. 22(3):409-13, 2007
Zhang H et al: The left renal entrapment syndrome: diagnosis and treatment. Ann Vasc Surg. 21(2):198-203, 2007
Ahmed K et al: Current trends in the diagnosis and management of renal nutcracker syndrome: a review. Eur J Vasc Endovasc Surg. 31(4):410-6, 2006
Culafic D et al: Spontaneous splenorenal shunt in a patient with liver cirrhosis and hypertrophic caudal lobe. J Gastrointestin Liver Dis. 15(3):289-92, 2006
Rudloff U et al: Mesoaortic compression of the left renal vein (nutcracker syndrome): case reports and review of the literature. Ann Vasc Surg. 20(1):120-9, 2006
Chang CT et al: Nutcracker syndrome and left unilateral haematuria. Nephrol Dial Transplant. 20(2):460-1, 2005
Cuellar i Calabria H et al: Nutcracker or left renal vein compression phenomenon: multidetector computed tomography findings and clinical significance. Eur Radiol. 15(8):1745-51, 2005
Kim SJ et al: Long-term follow-up after endovascular stent placement for treatment of nutcracker syndrome. J Vasc Interv Radiol. 16(3):428-31, 2005
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