Öz
Nutcracker syndrome refers to the compression of the left renal vein, usually between the aorta and the superior mesenteric artery. Flank pain is the most common complaint and hematuria can be seen among the laboratory findings. This syndrome, which is more common in women with low body mass index, can be difficult to diagnose.
A 41-year-old female patient with persistent left flank pain was admitted to our family medicine outpatient clinic. There was no finding that could explain the pain in the patient, who did not have any features in his history, despite many polyclinic applications. Computed tomography requested in our family medicine outpatient clinic revealed that the left renal vein was compressed between the aorta and the superior mesenteric artery, and the patient was diagnosed with nutcracker syndrome.
Nutcracker syndrome is an exclusion diagnosis that should be considered in patients who present with atypical left flank pain that is difficult to diagnose.
In the treatment, depending on the severity of the symptoms, a wide range of methods are applied, from conservative treatment to endovascular stenting and surgical treatment.
Anahtar Kelimeler
Kaynakça
- Granata A, Distefano G, Sturiale A, Figuera M, Foti P, Palmucci S Basile A. From Nutcracker Phenomenon to Nutcracker Syndrome: A Pictorial Review. Diagnostics. 2021; 11. 101. 10.3390/diagnostics11010101.
- Shaper KR, Jackson JE, Williams G. The nutcracker syndrome: an uncommon cause of haematuria. Br J Urol. 1994;74(2):144-146
- Shin JI, Park JM, Lee JS, Kim MJ. Effect of renal Doppler ultrasound on the detection of nutcracker syndrome in children with hematuria. Eur J Pediatr. 2007;166(5):399-404
- Shin JI, Lee JS, Kim MJ. The prevalence, physical characteristics, and diagnosis of nutcracker syndrome [letter]. Eur J Vasc Endovasc Surg. 2006;32(3):335-336
- Ananthan K, Onida S, Davies AH. Nutcracker Syndrome: An Update on Current Diagnostic Criteria and Management Guidelines. European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery. 2017;53. 10.1016/j.ejvs.2017.02.015.
- Kurklinsky A, Rooke T. Nutcracker Phenomenon and Nutcracker Syndrome. Mayo Clinic proceedings. Mayo Clinic. 2010;85. 552-9. 10.4065/mcp.2009.0586.
- Berthelot JM, Douane F, Maugars Y, Frampas E. Nutcracker syndrome: A rare cause of left flank pain that can also manifest as unexplained pelvic pain. Joint Bone Spine. 2017 Oct;84(5):557–62.
- Kim K, Cho J, Kim SH, Yoon J, Kim DS, Chung J, Park J. Diagnostic value of computed tomographic findings of nutcracker syndrome: Correlation with renal venography and renocaval pressure gradients. European journal of radiology. 2011;80. 648-54. 10.1016/j.ejrad.2010.08.044.
- Reed NR, Kalra M, Bower TC, Vrtiska TJ, Ricotta JJ, II, Gloviczki P. Left renal vein transposition for nutcracker syndrome. J Vasc Surg. 2009;49(2):386-394
- Velasquez CA, Saeyeldin A, Zafar MA, Brownstein AJ, Erben Y. A systematic review on the management of nutcracker syndrome. J Vasc Surg Venous Lymphat Disord. 2018 Mar;6(2):271–8.
Öz
Nutcracker sendromu, genellikle aort ve süperior mezenterik arter arasında, sol renal venin sıkışmasını ifade eder. Yan ağrısı en sık yakınmadır ve laboratuvar bulguları arasında hematüri görülebilir. Vücut kitle indeksi düşük olan kadınlarda daha sık görülen bu sendromun teşhisi zor olabilir.
41 yaşında kadın hasta kalıcı sol yan ağrısı şikâyeti ile aile hekimliği polikliniğimize başvurdu. Özgeçmişinde herhangi bir özellik bulunmayan hastada birçok poliklinik başvurusuna rağmen ağrıyı açıklayacak bir tanı konulamadı. Aile hekimliği polikliniğimizde istenen bilgisayarlı tomografide sol renal venin aorta ile süperior mezenterik arter arasında sıkıştığı saptandı ve hastaya Nutcracker sendromu tanısı konuldu.
Nutcracker sendromu, tanısı zor olup atipik sol yan ağrısı ile başvuran hastalarda düşünülmesi gereken bir ekartasyon tanısıdır.
Tedavide semptomların şiddetine göre konservatif tedaviden endovasküler stent ve cerrahi tedaviye kadar çok çeşitli yöntemler uygulanmaktadır.
Anahtar Kelimeler
Kaynakça
- Granata A, Distefano G, Sturiale A, Figuera M, Foti P, Palmucci S Basile A. From Nutcracker Phenomenon to Nutcracker Syndrome: A Pictorial Review. Diagnostics. 2021; 11. 101. 10.3390/diagnostics11010101.
- Shaper KR, Jackson JE, Williams G. The nutcracker syndrome: an uncommon cause of haematuria. Br J Urol. 1994;74(2):144-146
- Shin JI, Park JM, Lee JS, Kim MJ. Effect of renal Doppler ultrasound on the detection of nutcracker syndrome in children with hematuria. Eur J Pediatr. 2007;166(5):399-404
- Shin JI, Lee JS, Kim MJ. The prevalence, physical characteristics, and diagnosis of nutcracker syndrome [letter]. Eur J Vasc Endovasc Surg. 2006;32(3):335-336
- Ananthan K, Onida S, Davies AH. Nutcracker Syndrome: An Update on Current Diagnostic Criteria and Management Guidelines. European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery. 2017;53. 10.1016/j.ejvs.2017.02.015.
- Kurklinsky A, Rooke T. Nutcracker Phenomenon and Nutcracker Syndrome. Mayo Clinic proceedings. Mayo Clinic. 2010;85. 552-9. 10.4065/mcp.2009.0586.
- Berthelot JM, Douane F, Maugars Y, Frampas E. Nutcracker syndrome: A rare cause of left flank pain that can also manifest as unexplained pelvic pain. Joint Bone Spine. 2017 Oct;84(5):557–62.
- Kim K, Cho J, Kim SH, Yoon J, Kim DS, Chung J, Park J. Diagnostic value of computed tomographic findings of nutcracker syndrome: Correlation with renal venography and renocaval pressure gradients. European journal of radiology. 2011;80. 648-54. 10.1016/j.ejrad.2010.08.044.
- Reed NR, Kalra M, Bower TC, Vrtiska TJ, Ricotta JJ, II, Gloviczki P. Left renal vein transposition for nutcracker syndrome. J Vasc Surg. 2009;49(2):386-394
- Velasquez CA, Saeyeldin A, Zafar MA, Brownstein AJ, Erben Y. A systematic review on the management of nutcracker syndrome. J Vasc Surg Venous Lymphat Disord. 2018 Mar;6(2):271–8.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Olgu Sunumu |
| Yazarlar | |
| Yayımlanma Tarihi | 22 Haziran 2023 |
| Kabul Tarihi | 30 Mayıs 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 15 Sayı: 2 |
