scholarly journals Posterior Nutcracker Syndrome with Left Renal Vein Duplication: A Rare Cause of Haematuria in a 12-Year-Old Boy

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
J. Preza Fernandes ◽  
Rui Amorim ◽  
M. J. Gomes ◽  
V. Oliveira ◽  
A. Reis ◽  
...  
Keyword(s):  
Renal Vein ◽  
Left Renal Vein ◽  
Venous Blood ◽  
Additional Treatment ◽  
Venous Blood Flow ◽  
Nutcracker Syndrome ◽  
Bladder Irrigation ◽  
Renal Nutcracker Syndrome ◽  
Life Threatening ◽  
Posterior Nutcracker Syndrome

The nutcracker syndrome (NCS) is a rare cause of haematuria. It embraces an extended nonpathognomonic spectrum of symptoms that imply a difficult diagnosis. Ultimately it may be associated with substantial morbidity and even life-threatening events. We report a rare cause if a 12-year-old boy who presented with a history of frequent intermittent episodes of painless constant haematuria. The cystoscopy showed a bloody urine ejaculate from the left ureter meatus. The Doppler ultrasonography showed turbulent pattern of venous blood flow of the posterior renal vein branch behind the aorta. The abdominopelvic computer tomography (apCT) revealed left renal vein (LRV) duplication with a dilated retroaortic branch, entrapped between the aorta and the vertebral column, promoting the renal nutcracker syndrome. The patient was initially hospitalized and managed with oral iron supplements and continuous saline bladder irrigation, not requiring additional treatment. The child is currently asymptomatic, with haemoglobin value returning to normal and therefore proposed to conservative management with close followup. The authors present a case report of episodic haematuria caused by a rare entity—posterior nutcracker syndrome with renal vein duplication.

scholarly journals VS09 Robotic-Assisted Left Renal Vein Transposition: A Novel Surgical Technique for the Treatment of Renal Nutcracker Syndrome

2017 ◽  
Vol 65 (6) ◽  
pp. 141S
Author(s):  
Anthony Chau ◽  
Haidar Abdul-Muhsin ◽  
Kate Peng ◽  
Christopher Martin ◽  
Erik Castle ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Renal Vein ◽  
Left Renal Vein ◽  
Nutcracker Syndrome ◽  
Robotic Assisted ◽  
Renal Nutcracker Syndrome

scholarly journals Chronic Pelvic Pain and Hematuria Associated with Posterior Nutcracker Syndrome

2020 ◽  
Vol 06 (11) ◽  
Author(s):  
Dr. L. Belkouchi ◽  
Keyword(s):  
Superior Mesenteric Artery ◽  
Pelvic Pain ◽  
Renal Vein ◽  
Mesenteric Artery ◽  
Chronic Pelvic Pain ◽  
Anatomical Variation ◽  
Left Renal Vein ◽  
Young Patients ◽  
Nutcracker Syndrome ◽  
Posterior Nutcracker Syndrome

The nutcracker syndrome is a rare syndrome in which the left renal vein is compressed between the aorta and the superior mesenteric artery or even more rarely between the aorta and vertebral body, in case of an anatomical variation of the left renal vein. It is more likely discovered within young patients presenting pelvic pain, hematuria, or varicocele. Treatments vary from conservative, to surgical or endovascular. Here we present the case of a young patient with chronic pelvic pain and hematuria, diagnosed as a posterior nutcracker syndrome.

Nutcracker syndrome and phenomenon

2015 ◽  
Author(s):  
John Neary ◽  
Neil Turner
Keyword(s):  
Renal Vein ◽  
Incidental Finding ◽  
Left Renal Vein ◽  
Stent Migration ◽  
Nutcracker Syndrome ◽  
Pain Syndromes ◽  
Asymptomatic Patients ◽  
Weak Evidence ◽  
Life Threatening ◽  
Postural Proteinuria

Nutcracker syndrome describes symptomatology associated with obstruction to the left renal vein caused by pressure from the overlying superior mesenteric artery. Modern imaging methods show that some degree of left renal vein obstruction may be a common incidental finding in asymptomatic patients so it is better described as ‘nutcracker phenomenon’, NCP. The association of NCP with symptoms and signs is often speculative. NCP may be seen at any age but most patients with symptoms attributed to it are teenagers or young adults. The strongest evidence is for association with episodic macroscopic haematuria. There is weak evidence that it may in some circumstances account for orthostatic (postural) proteinuria, microscopic haematuria, or pain syndromes. Apart from rare examples of extreme haemorrhage the syndrome has not been associated with life-threatening features other than through complications of treatment. Various interventions have been employed, recently most commonly endovascular or extravascular approaches to stenting the vein, but serious adverse consequences from stent migration and thrombosis have been described.

Posterior nutcracker syndrome – a systematic review

VASA ◽  
2018 ◽  
Vol 47 (1) ◽  
pp. 23-29 ◽  
Author(s):  
Jae Hyon Park ◽  
Gi Hoon Lee ◽  
Seul Mi Lee ◽  
Michael Eisenhut ◽  
Andreas Kronbichler ◽  
...  
Keyword(s):  
Renal Vein ◽  
Left Renal Vein ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Final Analysis ◽  
Evidence Base ◽  
High Morbidity ◽  
Nutcracker Syndrome ◽  
Paediatric Age ◽  
Posterior Nutcracker Syndrome

Abstract. Posterior nutcracker syndrome (PNCS) is the entrapment of the left renal vein between the aorta and the vertebral column. Although uncommon, it is still an important diagnosis due to the high morbidity associated with the risk of secondary anaemia from haematuria, from long-term left renal vein hypertension, vascular thrombosis, and even blood clots in the urinary system. A literature search of PubMed and EMBASE databases was performed and 27 publications containing 27 cases were included for the final analysis. The following frequency of clinical signs and symptoms was noted: twenty-five patients had haematuria, 13 patients had flank pain, and two had hypertension. Overall, male-female distribution was balanced and there were more adult than paediatric (age < 18 years) patients. All symptoms of patients with conservative treatment were either well-controlled or under spontaneous resolution. Conservative management instead of surgical treatment should be preferred in most cases. Taken together, despite the low incidence of PNCS, its recognition and management are highly important. This systematic study explores the evidence base for conservative and medical options.

A Case of Posterior Nutcracker Syndrome Revealed in the Aerospace Environment

2021 ◽  
Vol 92 (1) ◽  
pp. 54-56
Author(s):  
Connie Y. Chung ◽  
Mark E. Lytle ◽  
Roselyn W. Clemente Fuentes
Keyword(s):  
Renal Vein ◽  
High Performance ◽  
Left Renal Vein ◽  
Flight Test ◽  
Nutcracker Syndrome ◽  
Important Lesson ◽  
Stressful Environment ◽  
Surgical Expertise ◽  
Posterior Nutcracker Syndrome ◽  
Rare Anatomic Variant

BACKGROUND: Nutcracker syndrome is caused by a rare anatomic variant where the left renal vein is trapped between the aorta and the superior mesenteric artery. Posterior nutcracker syndrome is an even rarer entity, characterized by the retro-aortic positioning of the renal vein, causing compression between the aorta and spinal vertebrae. Symptoms include microscopic or frank hematuria, flank pain, varicocele, pelvic congestion syndrome, and abdominal pain. A search of the literature did not reveal prior cases of nutcracker syndrome that became symptomatic and diagnosed secondary to the unique stressors of high gravitational force (G force) in the aviation environment.CASE REPORT: A 25-yr-old man training as an F-16 flight test engineer presented with left scrotal/testicular pain, varicocele, and intermittent gross hematuria. After an extensive workup, he was diagnosed with posterior nutcracker syndrome and underwent a left varicocele ligation with spermatic cord denervation. He was eventually able to be returned to flying duties with limitation to non-high performance aircraft.DISCUSSION: This case is particularly unique as its diagnosis was dependent on exposure to high G force conditions that may have otherwise remained asymptomatic without this environmental stressor. Education on the diagnosis of nutcracker syndrome as a differential in the setting of hematuria and pain is an important lesson learned. This case also illustrates the necessity of considering the effects of the stressful environment of high G force on even overall healthy individuals. Fortunately, due to the collaboration of medical-surgical expertise and familiarity with the requirements for operational readiness, this patient was able to resume his aviation career, albeit in a different capacity compatible with his condition.Chung CY, Lytle ME, Clemente Fuentes RW. A case of posterior nutcracker syndrome revealed in the aerospace environment. Aerosp Med Hum Perform. 2021; 92(1):5456.

scholarly journals Posterior nutcracker syndrome: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Cecilia Gozzo ◽  
Renato Farina ◽  
Pietro Valerio Foti ◽  
Francesco Aldo Iannace ◽  
Andrea Conti ◽  
...  
Keyword(s):  
Renal Failure ◽  
Doppler Ultrasound ◽  
Renal Vein ◽  
Left Renal Vein ◽  
Nutcracker Syndrome ◽  
First Line ◽  
Scrotal Pain ◽  
Chronic Hepatitis B Virus ◽  
Line Imaging ◽  
Posterior Nutcracker Syndrome

Abstract Background Posterior nutcracker syndrome is defined by the compression of the left renal vein between the abdominal aorta and a lumbar vertebral body. It can be clinically manifest with intermittent hematuria, gonadal or spermatic reflux resulting in varicocele. Ultrasound is the first-line imaging which require  more accurate study  with contrast-enhanced computed tomography. Management can be conservative in younger patients with mild hematuria due to the high spontaneous remission rate and invasive with open surgical and endovascular interventions. We describe a very rare case with compression of the left renal vein due to an osteophyte of the spine. Case presentation A 62-year-old Caucasic male came to our radiology department for chronic hepatitis B virus (HBV)-related liver disease follow-up and mild scrotal pain. The ultrasound examination revealed a compression of the left retro-aortic renal vein in the aorto-vertebral space caused by an osteophyte. Duplex Doppler ultrasound revealed flow congestion in the left renal vein and renal failure; power Doppler ultrasound showed left varicocele. Conclusions Doppler ultrasound is the first-line imaging and allows the detection of all the typical signs of posterior nutcracker: left renal vein stenosis, flow congestion and renal failure. Nutcracker syndrome should be suspected in older patients with left varicocele associated with hematuria. Failure to diagnose and treat these patients could have serious consequences for their health.

Sign in / Sign up

Export Citation Format

Share Document