title: Nutcracker or left renal vein compression phenomenon: multidetector computed tomography findings and clinical significance.
abstract: 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.
authors.affiliation: 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
authors.forename: Hug
authors.initials: H
authors.lastname: Cuéllar i Calàbria
authors.forename: Sergi
authors.initials: S
authors.lastname: Quiroga Gómez
authors.forename: Carmen
authors.initials: C
authors.lastname: Sebastià Cerqueda
authors.forename: Rosa
authors.initials: R
authors.lastname: Boyé de la Presa
authors.forename: Américo
authors.initials: A
authors.lastname: Miranda
authors.forename: Agustí
authors.initials: A
authors.lastname: Alvarez-Castells
mesh_terms: 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*
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