title: The nutcracker syndrome: new aspects of pathophysiology, diagnosis and treatment.
abstract: Magnetic resonance imaging (MRI) was used to study vascular anatomy in 3 patients with the nutcracker syndrome and in 10 healthy volunteers. From these studies an abnormal branching of the superior mesenteric artery from the aorta was identified as being the cause of the nutcracker syndrome. Consequently, surgical transposition of the left renal vein to achieve an unobstructed renal venous backflow was performed successfully in 2 patients, while 1 underwent nephrectomy. In 1 patient adjuvant ureteral instrumentation became necessary to aid occlusion of persisting shunts between peripelvic venous varicosities and the urinary tract. Awareness of the pathophysiology of the nutcracker syndrome ensures an early diagnosis, which should be confirmed by a combination of diagnostic procedures, including MRI.
authors.affiliation: Department of Urology, Klinikum Barmen, Wuppertal, Federal Republic of Germany.
authors.forename: M
authors.initials: M
authors.lastname: Hohenfellner
authors.forename: F
authors.initials: F
authors.lastname: Steinbach
authors.forename: D
authors.initials: D
authors.lastname: Schultz-Lampel
authors.forename: W
authors.initials: W
authors.lastname: Schantzen
authors.forename: K
authors.initials: K
authors.lastname: Walter
authors.forename: B M
authors.initials: BM
authors.lastname: Cramer
authors.forename: J W
authors.initials: JW
authors.lastname: Thüroff
authors.forename: R
authors.initials: R
authors.lastname: Hohenfellner
mesh_terms: D000328:Adult; D000368:Aged; D001011:Aorta / Q000473:pathology; D003251:Constriction, Pathologic; D005260:Female; D006417:Hematuria; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008638:Mesenteric Arteries / Q000473:pathology; D008875:Middle Aged; D009392:Nephrectomy; D012082:Renal Veins / Q000473:pathology / Q000503:physiopathology*; D013577:Syndrome; D014648:Varicose Veins; D014652:Vascular Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D014690:Venous Pressure