Nutcracker phenomenon: a new diagnostic method of multislice computed tomography angiography.
OBJECTIVE
We evaluated 3-D computed tomography angiography (3-D CTA) in the diagnosis of the nutcracker phenomenon, and its significance in postoperative follow up.


METHODS
Three-dimensional CTA was used to compare the anatomical relations of the left renal vein with the aorta and the superior mesenteric artery in patients with the nutcracker phenomenon and in a control group. Four patients with the nutcracker phenomenon received a surgical procedure of the transposition of the left renal vein. The 3-D CTA was used for all patients during postoperation follow-up testing.


RESULTS
The 3-D CTA showed a compression of the left renal vein between the aorta and the superior mesenteric artery (SMA) and the abnormal acute angle between them. The angles and distances between the SMA and the aorta were 39.3 +/- 4.3 degrees and 3.1 +/- 0.2 mm in the patient groups and 90 +/- 10 degrees and 12 +/- 1.8 mm in the control groups, respectively. Differences in angles and distances were statistically significant between the two groups (P < 0.05). Surgical transposition of the left renal vein was performed successfully. Postoperative 3-D CTA revealed the distance between the SMA and the aorta was nearly normal.


CONCLUSIONS
The reconstruction imaging of the renal vein by means of 3-D CTA revealed that unusual hematuria was due to compression of the left renal vein; therefore it may be a useful alternative imaging technique instead of conventional examinations. The non-invasive 3-D CTA may be a useful tool in the diagnosis of the nutcracker phenomenon and follow-up testing.
Fu
Wei-Jun
WJ
Department of Urology, Chinese People's Liberation Army General Hospital, Military Postgraduate Medical College, Beijing, China. fuweijun@hotmail.com
Hong
Bao-Fa
BF
Gao
Jiang-Ping
JP
Xiao
Yue-Yong
YY
Yang
Yong
Y
Cai
Wei
W
Guo
Gang
G
Wang
Xiao Xiong
XX
D000293:Adolescent; D000792:Angiography / Q000379:methods*; D003251:Constriction, Pathologic / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006417:Hematuria / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male; D012082:Renal Veins / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed