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Renal Vein Nutcracker
Margarita Revzin, MD, MS, FSRU; Corinne Deurdulian, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            • Scanning Tips

              TERMINOLOGY

              • Abbreviations

                • Nutcracker syndrome (NCS)
                • Nutcracker phenomenon (NCP)
              • Synonyms

                • Left renal vein entrapment
              • Definitions

                • NCS: Symptomatic compression of left renal vein (LRV) between aorta and superior mesenteric artery (SMA), resulting in LRV outflow obstruction. Presence of clinical symptoms is required for diagnosis
                • NCP: LRV entrapment between aorta and SMA; however, without accompanied clinical symptoms. In NCP anatomic nutcracker features may exist without sequelae

              IMAGING

              • General Features

                • Ultrasonographic Findings

                  • Radiographic Findings

                    • CT Findings

                      • MR Findings

                        • Angiographic Findings

                          • Imaging Recommendations

                            DIFFERENTIAL DIAGNOSIS

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Hangge PT et al: Degree of left renal vein compression predicts nutcracker syndrome. J Clin Med. 7(5), 2018
                                          2. Velasquez CA et al: A systematic review on management of nutcracker syndrome. J Vasc Surg Venous Lymphat Disord. 6(2):271-278, 2018
                                          3. Fong JK et al: Imaging findings and clinical features of abdominal vascular compression syndromes. AJR Am J Roentgenol. 203(1):29-36, 2014
                                          4. He Y et al: Nutcracker syndrome--how well do we know it? Urology. 83(1):12-7, 2014
                                          5. Kim KW et al: Diagnostic value of computed tomographic findings of nutcracker syndrome: correlation with renal venography and renocaval pressure gradients. Eur J Radiol. 80(3):648-54, 2011
                                          6. Kurklinsky AK et al: Nutcracker phenomenon and nutcracker syndrome. Mayo Clin Proc. 85(6):552-9, 2010
                                          7. Shin JI et al: Effect of renal Doppler ultrasound on the detection of nutcracker syndrome in children with hematuria. Eur J Pediatr. 166(5):399-404, 2007
                                          8. 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
                                          9. Park SJ, Lim JW, Cho BS, Yoon TY, Oh JH. Nutcracker syndrome in children with orthostatic proteinuria: diagnosis on the basis of Doppler sonography. J Ultrasound Med. 21(1):39-45, 2002
                                          10. Takebayashi S et al: Diagnosis of the nutcracker syndrome with color Doppler sonography: correlation with flow patterns on retrograde left renal venography. AJR Am J Roentgenol. 172(1):39-43, 1999
                                          11. Stavros AT et al: Color duplex sonography of the nutcracker syndrome (aortomesenteric left renal vein compression). J Ultrasound Med. 13(7):569-74, 1994
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Clinical Issues

                                                  • Diagnostic Checklist

                                                    • Scanning Tips

                                                      TERMINOLOGY

                                                      • Abbreviations

                                                        • Nutcracker syndrome (NCS)
                                                        • Nutcracker phenomenon (NCP)
                                                      • Synonyms

                                                        • Left renal vein entrapment
                                                      • Definitions

                                                        • NCS: Symptomatic compression of left renal vein (LRV) between aorta and superior mesenteric artery (SMA), resulting in LRV outflow obstruction. Presence of clinical symptoms is required for diagnosis
                                                        • NCP: LRV entrapment between aorta and SMA; however, without accompanied clinical symptoms. In NCP anatomic nutcracker features may exist without sequelae

                                                      IMAGING

                                                      • General Features

                                                        • Ultrasonographic Findings

                                                          • Radiographic Findings

                                                            • CT Findings

                                                              • MR Findings

                                                                • Angiographic Findings

                                                                  • Imaging Recommendations

                                                                    DIFFERENTIAL DIAGNOSIS

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Hangge PT et al: Degree of left renal vein compression predicts nutcracker syndrome. J Clin Med. 7(5), 2018
                                                                                  2. Velasquez CA et al: A systematic review on management of nutcracker syndrome. J Vasc Surg Venous Lymphat Disord. 6(2):271-278, 2018
                                                                                  3. Fong JK et al: Imaging findings and clinical features of abdominal vascular compression syndromes. AJR Am J Roentgenol. 203(1):29-36, 2014
                                                                                  4. He Y et al: Nutcracker syndrome--how well do we know it? Urology. 83(1):12-7, 2014
                                                                                  5. Kim KW et al: Diagnostic value of computed tomographic findings of nutcracker syndrome: correlation with renal venography and renocaval pressure gradients. Eur J Radiol. 80(3):648-54, 2011
                                                                                  6. Kurklinsky AK et al: Nutcracker phenomenon and nutcracker syndrome. Mayo Clin Proc. 85(6):552-9, 2010
                                                                                  7. Shin JI et al: Effect of renal Doppler ultrasound on the detection of nutcracker syndrome in children with hematuria. Eur J Pediatr. 166(5):399-404, 2007
                                                                                  8. 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
                                                                                  9. Park SJ, Lim JW, Cho BS, Yoon TY, Oh JH. Nutcracker syndrome in children with orthostatic proteinuria: diagnosis on the basis of Doppler sonography. J Ultrasound Med. 21(1):39-45, 2002
                                                                                  10. Takebayashi S et al: Diagnosis of the nutcracker syndrome with color Doppler sonography: correlation with flow patterns on retrograde left renal venography. AJR Am J Roentgenol. 172(1):39-43, 1999
                                                                                  11. Stavros AT et al: Color duplex sonography of the nutcracker syndrome (aortomesenteric left renal vein compression). J Ultrasound Med. 13(7):569-74, 1994