Adel Ekladious^1,2*

¹University of Western Australia 35 Stirling Hwy, Crawley, Western Australia
²Royal Hobart hospital, Tasmania, Australia

*Corresponding Author: Adel Ekladious, Associate professor of Medicine. Mobile: 61499449904, E-mail: ekladiou@gmail.com

Received: November 08, 2021; Published: December 15, 2021

Abstract

Nutcracker Syndrome is a rare condition that presents with variable non-specific symptoms and signs including loin pain, chronic pain syndrome, macroscopic and microscopic haematuria, orthostatic albuminuria, occasionally varicocele, infrequently chronic renal failure. As a result, these patients are often treated as pyelonephritis or diagnosed with benign orthostatic albuminuria. They may also be subject further investigation with cystoscopy by urology. It is not uncommon for these patients to be labelled with chronic pain syndrome, functional pain syndrome or fibromyalgia, with significant morbidity involving chronic pain poorly controlled with analgesia. We present a 29-year-old medical student with chronic pain, who was given a diagnosis of fibromyalgia. Following recurrent presentations to emergency department with left loin pain and intermittent haematuria, the patient was admitted under urology for further investigation. Doppler ultrasound, CT, and MRI showed compression of the Left Renal Vein (LRV) between superior mesenteric artery and adnominal aorta confirming the diagnosis of nutcracker syndrome. The patient opted for endovascular therapy with left renal vein stenting that resulted in resolution of all symptoms. Although nutcracker syndrome is a rare condition, a low threshold to discuss radiological findings with a senior radiologist is required to exclude nutcracker syndrome once common causes of haematuria and loin pain have been ruled out. Failure to diagnose Nutcracker in a timely manner can lead to serious complication and irreversible kidney injury.

Keywords: Renal Vein; Kidney; Nutcracker Syndrome

References

1. Case courtesy of Dr Safwat Mohammad Almoghazy.
2. J Grant Anonymous. “Method of anatomy”. Williams and Wilkins, Baltimore, MD (1937): 137.
3. A de Schepper. “Nutcracker (Phenomenon of the left renal vein and venous pathology of the left kidney”. Journal of the Belgian Society of Radiology 55 (1972): 507-511.
4. JI Shin., et al. “The prevalence, Physical Characteristics and Diagnosis of Nutcracker Syndrome”. European Journal of Vascular and Endovascular Surgery3 (2006): 335-336.
5. K Ahmed., et al. “Current trends in the diagnosis and management of renal nutcracker syndrome: Review”. European Journal of Vascular and Endovascular Surgery 31 (2006): 410-416.
6. AH Sculteus., et al. “The Nutcracker Syndrome: its role in the pelvic venous disorders”. Journal of Vascular Surgery 34 (2001): 812-819.
7. KW Kim., et al. “Diagnostic value of Computed Tomographic findings of Nutcracker syndrome: Correlation with renal venography and reno caval pressure gradients”. European Journal of Radiology 80 (2001): 468-654.
8. Xu D., et al. “Management of renal nutcracker syndrome by retroperitoneal Laparoscopic nephrectomy with ex vivo autograft repair and auto transplantation: a case report and review of the literature”. Journal of Medical Case Reports82 (2009).

Citation

Citation: Adel Ekladious. “Nutcracker Syndrome". Acta Scientific Medical Sciences 6.1 (2022): 171-173.

Copyright

Copyright: © 2022 Adel Ekladious. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.