Nutcracker or left renal vein compression phenomenon: multidetector computed tomography findings and clinical significance.
The use of multidetector computed tomography (MDCT) in routine abdominal explorations has increased the detection of the nutcracker phenomenon, defined as left renal vein (LRV) compression by adjacent anatomic structures. The embryology and anatomy of the nutcracker phenomenon are relevant as a background for the nutcracker syndrome, a rare cause of hematuria as well as other symptoms. MDCT examples of collateral renal vein circulation (gonadal, ureteric, azygous, lumbar, capsular) and aortomesenteric (anterior) and retroaortic (posterior) nutcracker phenomena in patients with no urologic complaint are shown as well as studies performed on patients with gross hematuria of uncertain origin. Incidental observation of collateral veins draining the LRV in abdominal MDCT explorations of asymptomatic patients may be a sign of a compensating nutcracker phenomenon. Imbalance between LRV compression and development of collateral circulation may lead to symptomatic nutcracker syndrome.
Cuéllar i Calàbria
Hug
H
Institut de Diagnòstic Per La Imatge, Servei De Radiodiagnòstic, Hospitals Universitaris Vall D' Hebron, Passeig de la Vall d' Hebron no.119-129, 08035, Barcelona, Spain. hugcuellar@terra.es
Quiroga Gómez
Sergi
S
Sebastià Cerqueda
Carmen
C
Boyé de la Presa
Rosa
R
Miranda
Américo
A
Alvarez-Castells
Agustí
A
D003251:Constriction, Pathologic / Q000000981:diagnostic imaging; D006801:Humans; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging*; D012082:Renal Veins / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D014652:Vascular Diseases / Q000000981:diagnostic imaging*
Br J Urol. 1994 Aug;74(2):144-6
7921928
Transplant Proc. 2003 Mar;35(2):851-3
12644163
Nephrol Dial Transplant. 2000 Jan;15(1):99-101
10607775
Urology. 2001 Apr;57(4):599-603
11306356
Radiology. 1996 Jan;198(1):93-7
8539413
J Urol. 1996 Apr;155(4):1173-9
8632525
Eur Radiol. 2002 Dec;12 Suppl 3:S133-5
12522623
Pediatr Nephrol. 2002 May;17 (5):379-81
12042899
AJR Am J Roentgenol. 1999 Jan;172(1):39-43
9888735
J Urol. 1991 Sep;146(3):685-8
1875472
J Ultrasound Med. 2002 Jan;21(1):39-45; quiz 46
11794401
Surg Radiol Anat. 1999;21(1):77-81
10370998
Urology. 2002 Mar;59(3):354-7
11880069
J Ultrasound Med. 2000 Sep;19(9):627-31
10972559
Br J Urol. 1994 Aug;74(2):139-43
7921927
J Anat. 1995 Apr;186 ( Pt 2):405-9
7649840
AJR Am J Roentgenol. 2002 Sep;179(3):625-7
12185031
AJR Am J Roentgenol. 1980 Aug;135(2):339-42
6773339
AJR Am J Roentgenol. 2001 Jan;176(1):119-22
11133549
Pediatr Nephrol. 1997 Apr;11(2):218-20
9090670
Cardiovasc Intervent Radiol. 1993 May-Jun;16(3):189-92
8334693
Urology. 1999 May;53(5):873-80
10223477
Clin Nephrol. 2000 Mar;53(3):174-81
10749295
J Urol. 2003 Jun;169(6):2293-4
12771774
J Vasc Interv Radiol. 1998 Mar-Apr;9(2):339-45
9540920
Radiology. 1982 Jun;143(3):649-52
7079491
Pediatr Nephrol. 2000 Sep;14(10-11):1002-5
10975316