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BioMed Research International
Volume 2017, Article ID 1746570, 7 pages
https://doi.org/10.1155/2017/1746570
Review Article

What Each Clinical Anatomist Has to Know about Left Renal Vein Entrapment Syndrome (Nutcracker Syndrome): A Review of the Most Important Findings

1Department of Angiology, Medical University of Łódź, Narutowicza 60, 90-136 Łódź, Poland
2Department of Normal and Clinical Anatomy, Medical University of Łódź, Narutowicza 60, 90-136 Łódź, Poland
3Department of Radiological and Isotopic Diagnosis and Therapy, Medical University of Łódź, ul. Żeromskiego 113, 90-549 Łódź, Poland
4Department of Radiology, Medical University of Łódź, Kopcińskiego 22, 90-153 Łódź, Poland

Correspondence should be addressed to Michał Polguj; lp.zdol.demu@juglop.lahcim

Received 14 April 2017; Accepted 12 October 2017; Published 11 December 2017

Academic Editor: Hossein Tezval

Copyright © 2017 Krzysztof Orczyk et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Nutcracker syndrome (NCS) is the most common term for compression of the left renal vein between the superior mesenteric artery and the abdominal aorta. The development of NCS is associated with the formation of the left renal vein (LRV) from the aortic collar during the sixth to eighth week of gestation and abnormal angulation of the superior mesenteric artery from the aorta. Collateralization of venous circulation is the most significant effect of NCS. It includes mainly the left gonadal vein and the communicating lumbar vein. Undiagnosed NCS may affect retroperitoneal surgery and other radiological and vascular procedures. The clinical symptoms of NCS may generally be described as renal presentation when symptoms like haematuria, left flank pain, and proteinuria occur, but urologic presentation is also possible. Radiological methods of confirming NCS include Doppler ultrasonography as a primary test, retrograde venography, which can measure the renocaval pressure gradient, computed tomography angiography, which is faster and less traumatic, intravascular ultrasound, and magnetic resonance angiography. Treatment can be conservative or surgical, depending on the severity of symptoms and degree of LRV occlusion. Nutcracker syndrome is worth considering especially in differential diagnosis of haematuria of unknown origin.