Linked Life Data

9433099

Source:http://linkedlifedata.com/resource/pubmed/id/9433099

Statements in which the resource exists as a subject.
PredicateObject
rdf:type
lifeskim:mentions
pubmed:issue
12
pubmed:dateCreated
1998-2-26
pubmed:abstractText
Since its description in 1972, the Nutcracker Syndrome or Aorto-Mesenteric Left Renal Vein Entrapment Syndrome has been mentioned in the literature as an infrequent cause of hematuria originating from the left collecting system. It describes compression of the left renal vein in the fork between the abdominal aorta and the proximal Superior Mesenteric Artery (SMA), close to its origin. This results in left renal venous hypertension leading to the development of collateral veins with intrarenal and perirenal varicosities which can cause hematuria if the thin-walled septum separating the veins from the collecting system ruptures. The main presenting symptom is hematuria, with or without left flank pain. Some patients may present with left flank pain alone and, in a few, varicocele might be the only complaint. Exercise seems to aggravate the symptoms. It still remains unclear why compression of the left renal vein occurs in only a few patients despite its very peculiar course between the aorta and the SMA. Different anatomical details have been proposed. This controversy reflected itself on the lack of a clear agreement in regard to the treatment. We did a general overview of the current literature in an effort to elucidate further its pathophysiology. We present here three cases. The first case is that of a lady who presented with intermittent hematuria, sixteen years apart. Her hematuria cleared spontaneously without surgical intervention. Given her long symptom free interval, we strongly suspect some variable constitutional factors to play a role in the symptom development. The second case represents a perfectly healthy asymptomatic young women in whom an IVP done as routine renal donor work up revealed irregularities within the left collecting system that proved to be periureteric varices secondary to a nutcracker phenomenon as proved later by a renal angiogram. The third case describes a hypertensive, otherwise healthy, middle-aged male in whom an asymptomatic Nutcracker Phenomenon disclosed itself during a renal angiographic work up for his intractable hypertension. It is likely that the incidence of this anatomical problem is rather underestimated. We would like to emphasize the importance of its early inclusion in the differential diagnosis of left-sided hematuria because of the need for special testing for its diagnosis. Early proper diagnosis would spare many unneeded investigations.
pubmed:language
eng
pubmed:journal
pubmed:citationSubset
IM
pubmed:status
MEDLINE
pubmed:month
Dec
pubmed:issn
0038-3317
pubmed:author
pubmed:issnType
Print
pubmed:volume
50
pubmed:owner
NLM
pubmed:authorsComplete
Y
pubmed:pagination
429-36
pubmed:dateRevised
2009-11-11
pubmed:meshHeading
pubmed:year
1997
pubmed:articleTitle
Nutcracker syndrome: an underdiagnosed cause for hematuria?
pubmed:publicationType
Journal Article, Review, Case Reports