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2020, Number 4

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Rev Cubana Pediatr 2020; 92 (4)

Characterization of Nutcracker Syndrome

Serrano CEM, Durán ÁS, Diaz ZN, Campañá CN, Sosa PO, Severino HJ

Language: Spanish
References: 35
Page: 1-17
PDF size: 490.84 Kb.


ABSTRACT

Introduction: Nutcracker syndrome (NCS) is a vascular anomaly which is rarely searched and diagnosed due to its low incidence and because of the difficulty to suspect on it among other frequent clinical manifestations.
Objective: To examine clinical and imaging characteristics of patients diagnosed with NCS.
Methods: Descriptive, retrospective and prospective study in patients admitted in “William Soler” University Pediatric Hospital in the period from January, 2013 to December, 2017. When it was suspected the presence of the syndrome, it was made an ultrasound looking for dilation of the left renal vein and the output angle of the superior mesenteric artery. In 7 patients it was made an angio-TAC. The epidemiologic, clinical, laboratory and imaging variables were reviewed.
Presentation of cases: From the total of 9 patients diagnosed with a vascular anomaly; 6 (66,7%) were males. The mean age was 11,4 years (range 7-15 years). It was diagnosed front NCS in 7 patients (77.7%), back NCS in 1 patient (11.1%) and Wilkie syndrome with associated NCS in 1 patient (11.1%). 100% of the cases presented abdominal or lumbar pain related to hematuria (4 patients), foaming urine (4 patients) and left varicocele in 2 of the male patients (33.3%).
Conclusions: Nutcracker syndrome should be searched in patients presenting frequent abdominal, lumbar or left side pain, recurrent hematuria or orthostatic proteinuria episodes. In males with left varicocele should be discounted this possibility. Nutcracker phenomenon can be also diagnosed when the patient is being investigated due to not related causes.


REFERENCES

  1. Sriajjakul S, Prapaisilp P, Bangchokdee S. Imaging features of vascular compression in abdomen. Fantasy, phenomenon or true syndrome, Indian J Radiol Imaging. 2017;27:216-24.

  2. Korkes F. Nutcracker syndrome: How are we cracking the nuts and whose nuts are cracking? Int Braz J Urol. 2017;43:788-90.

  3. Dellavedona T. Síndrome de cascanueces: Comunicación de un caso. Rev Mex Urol. 2010;70:51-4.

  4. Vidarte O, Salinas C, Quiroa F, Melgarejo W, Medina R, Zegarra L. Hematuria macroscópica persistente causada por el síndrome de cascanueces. Rev Med Hered, 2000;11:34-9.

  5. De Schepper A, "Nutcracker" phenomenon of the renal vein and venous pathology of the left kidney. J Belge Radiol.1972;55:507-11.

  6. Del Canto Perunera P, Vaquero Lorenzo F, Vallina-Victorero Vázquez MJ, Álvarez Salgado A, Vicente Santiago M, Rojas Velasco M, et al. Recurrent hematuria caused by nutcracker syndrome. Ann Vasc Surg. 2014;28:e15-e19.

  7. Lewis DS, Grimm LJ, Kim CY, Left renal vein compression as cause for varicocele: Prevalence and associated finding on contrast-enhance CT. Abdom Imaging, 2015;40:3147-51.

  8. Rudloff V, Holmes RI, Faust GR, Moldwin R, Siegel D. Mesoaortic compression of the renal vein (nutcracker syndrome): Case report and review of the literature. Ann Vasc Surg, 2006;20:120-9.

  9. Ekwenna O, Gorin MA, Castellan M, Casillas V, Ciancio C. Inverted nutcracker syndrome: A case of persistent hematuria and flank pain in presence of left-side inferior vena cava. Scientific World J. 2011;11:1301-5.

  10. Kurklinsky AK, Rooke TW. Nutcracker phenomenon and nutcracker syndrome. Mayo Clin Proc. 2010;85:552-9.

  11. Vianello FA, Mazzoni MBM, Peeters GB, Fossali E, Camozzi P, Bianchetti MB, et al. Micro- and macroscopic hematuria caused by renal vein entrapment: Systematic review of the literature. Pediatr Nephrol. 2016;31:175-84.

  12. Quintana de la Cruz R, Pastor Sánchez C, Goic Ortiz V, Zarca Diaz de la Espina MA, Torres Sousa MY, Villanueva Liñán J. Pinza aorto mesentérica, dos patologías en una poster S-0966. Sociedad Española de Radiologia Médica (SERAM). España: Congreso SERAN; 2014. doi:http://dx.doi.org/10.1594/seran2014/S-0966.

  13. Michael PE, Al-Saadi T, Jamkhandikar R. A rare case of coexisting superior mesenteric artery syndrome and nutcracker phenomenon.Sultan Qaboos Univ Med J. 2017;17:e368-e370.

  14. Alvarenga A, Espinheira C, Guerra P, García M, Abreu M, Campos M. Superior mesenteric artery syndrome: Weight loss can be a problem, weight gain can be a solution. GE Port J Gastroenterol. 2017;24:43-6.

  15. Oh MJ. Superior mesenteric artery syndrome combined with renal nutcracker syndrome in a young child. A case report. Korean J Gastroenterol. 2017;70:253-60.

  16. Oseguera de Rodriguez EJ, Hernández-Villegas AC, Serralde-Zúñiga AE, Reyes-Ramírez ALDC. The two sides of superior mesenteric artery syndrome: Conservative or surgical treatment? Nutr Hosp. 2017;34:97-100.

  17. Takahashi Y, Sato A, Matsoo M, An ultrasonographic classification for diverse clinical symptoms of pediatric nutcracker phenomenon. Clin Nephrol. 2005;64:47-50.

  18. Atkinson TH, Love M, Messer J. Gross hematuria caused by nutcracker syndrome and segmental pseudoaneurism. Can J Urol. 2015;22:7445-7.

  19. Bechmann CF, Abrams HC, idiopathic renal vein varices: Incidence and signification. Radiology. 1982;143:649-52.

  20. Berthelot JM, Dovane F, Maugars Y, Frampas E. Nutcracker syndrome: A rare cause of left flank pain that can also manifest as unexplained pelvic pain. Join Bone Spine. 2017;84:557-62.

  21. Rogers A, Beech A, Brairhwaite B. Transperitoneal laparoscopic left gonadal ligation can be right treatment option for pelvis congestion secondary to nutcracker syndrome. Vascular Surg. 2007;15.238-45.

  22. Unlu M, Orguc S, Serter S, Pekindil G, Pobascu Y. Anatomic and hemodynamic evaluation of renal venous flow in varicocele formation using color Doppler sonography with enfasis on renal vein entrapment syndrome. Scand J Urol Nephrol. 2007;41:42-8.

  23. Coolsaet BL. Ureteric pathology in relation to right and left gonadal veins. Urology. 1978;12:40-9.

  24. Hulsberg PC, McLoney E, Partovi S, Davidson JC, Patel IJ. Minimally invasive treatment for venous compression syndromes. Cardiovasc Diagn Ther. 2016;6:582-92.

  25. Park SJ, Shin JJ. Renal Doppler ultrasonography in the diagnosis of nutcracker syndrome. Eur J Pediatr. 2013;172:135-6.

  26. Zucker EJ, Ganguli S, Ghoshhajra AB, Gupta R, Prabhakar AM. Imaging of venous compression syndrome,.Cardiovasc Diagn Ther. 2016;6:519-32.

  27. Khoedear Y, Al-Ramli W, Bodnar Z. Laparoscopic management of a complicated case of Wilkie´s syndrome: A case report. Int Surg Case Rep. 2017;37:177-9.

  28. Zaraket V, Abdelsayed G, Frank G, Deeb L. Wilkie´s syndrome: A rare cause of intestinal obstruction. Am J Gastroenterol. 2014;109:S330.

  29. Inal M, Unal Daphan B, Karadeniz Bilgili MY. Superior mesenteric artery syndrome accompanying with nutcracker syndrome: A case report. Iran Red Crescent J. 2014;16.16:e14755. doi:10.5812/ircmj.14755.

  30. Nahmood SK, Oliveira GR, Rosovsky RP. An easily missed diagnosis: Flank pain an nutcracker syndrome. BMJ Case Rep. 2013;2013:bcr2012009447 doi: 10.1138/bcr.2013.009447. Epub: 2013 May 24.,

  31. Anathan K, Owida S, Davies AH. Nutcracker syndrome: An update on current diagnostic criteria and management guidelines. Eur J Vasc Endovasc Surg. 2017;53:886-94.

  32. Wu Z, Zheng X, He Y, Fang X, Li D, Tian L, et al. Stent migration after endovascular stenting in patients with nutcracker syndrome. J Vasc Surg Venous Lymphat Disord. 2016;4:193-9.

  33. Hen S, Zhang H, Tian L, Li M, Zhong M, Wang Z. A stranger in the heart: LRV stent migration. Urol Nephrol. 2009;41:427-30.

  34. Ullery BW, Itoga NK, Mell MW. Transposition of the left renal vein for the treatment of nutcracker syndrome in children: A short-term experience. Ann Vasc Surg. 2014;28; e5-8.

  35. Campañá Cobas NG, Durán Álvarez S, Abradelo Rodriguez AF, Diaz Zayas N, Hernández Hernández JS. Síndrome de cascanueces, a propósito de dos casos. Rev Cubana Pediatr. 2015 [acceso 10/06/2018];87(3). Disponible en: http://scielo.sld.cu/scielo,php?script=sci_arttext&pid=S0034-753120140003000148-inf=es




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