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      Nutcracker Syndrome Complicated by Left Renal Vein Thrombosis

      case-report

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          Abstract

          Isolated renal vein thrombosis is a rare entity. We present a patient whose complaint of flank pain led to the diagnosis of a renal vein thrombosis. In this case, abdominal computed tomography angiography was helpful in diagnosing the nutcracker syndrome complicated by the renal vein thrombosis. Anticoagulation was started and three weeks later, CTA showed complete disappearance of the renal vein thrombosis. To treat the Nutcracker syndrome, we proposed left renal vein transposition that the patient consented to.

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          Nutcracker phenomenon and nutcracker syndrome.

          Andrew K Kurklinsky, Thom W Rooke (2010)
          Nutcracker phenomenon refers to compression of the left renal vein, most commonly between the aorta and the superior mesenteric artery, with impaired blood outflow often accompanied by distention of the distal portion of the vein. The nutcracker syndrome (NCS) is the clinical equivalent of nutcracker phenomenon characterized by a complex of symptoms with substantial variations. Depending on specific manifestations, NCS may be encountered by different medical specialists. Although it may be associated with substantial morbidity, the diagnosis of NCS is often difficult and is commonly delayed. Diagnostic and treatment criteria are not well established, and the natural history of NCS is not well understood. We performed an initial review of the literature through MEDLINE, searching from 1950 to date and using the keywords nutcracker syndrome, nutcracker phenomenon, and renal vein entrapment. We performed additional reviews based on the literature citations of the identified articles. We attempted to elucidate clinical relevance of these conditions and their prominent features and to summarize professional experience.
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            The "nutcracker" phenomenon: an unusual cause for renal varicosities with hematuria.

            R Wendel, E Crawford, K N Hehman (1980)
            The "nutcracker" phenomenon refers to renal vein compression by the aorta and superior mesenteric artery where the vein courses in the fork formed at the bifurcation of these arteries. Renal varicosities with hematuria developed in our patient in response to obstruction of the renal vein at this site. Surgical exploration revealed the left renal vein to be compressed by and stretched over the abdominal aorta. This deformity was corrected by medial fixation of the kidney and excision of extensive renal varicosities involving periureteral and ovarian veins. The patient has experienced no further hematuria.
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              An easily missed diagnosis: flank pain and nutcracker syndrome

              S. Mahmood, G. R. Oliveira, R. Rosovsky (2013)
              Article 0 comments Cited 13 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Case Rep Urol
                Journal ID (iso-abbrev): Case Rep Urol
                Journal ID (publisher-id): CRIM.UROLOGY
                Title: Case Reports in Urology
                Publisher: Hindawi Publishing Corporation
                ISSN (Print): 2090-696X
                ISSN (Electronic): 2090-6978
                Publication date (Print): 2013
                Publication date (Electronic): 24 November 2013
                Volume: 2013
                Electronic Location Identifier: 168057
                Affiliations
                1Department of Urology, Hospital of Sahloul, 4054 Sousse, Tunisia
                2Department of Radiology, Hospital of Sahloul, 4054 Sousse, Tunisia
                Author notes

                Academic Editors: S. K. Hong and J. Park

                Article
                DOI: 10.1155/2013/168057
                PMC ID: 3857899
                PubMed ID: 24349817
                SO-VID: 316a2b13-d4cc-4d34-ada4-849e342ea339
                Copyright © Copyright © 2013 Faouzi Mallat et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 5 July 2013
                Date accepted : 3 September 2013
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Urology
                Data availability:
                ScienceOpen disciplines: Urology

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