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Year : 2020  |  Volume : 6  |  Issue : 3  |  Page : 59-63

Nutcracker syndrome at a Glance

1 Department of Nephrology, 404 General Military Hospital, Larissa, Greece
2 Department of Neurosurgery, University of Thessaly, Larissa, Greece
3 School of Medicine, European University Cyprus, Nicosia, Cyprus

Correspondence Address:
Dr. Dimitrios C Karathanasis
Department of Nephrology, 404 General Military Hospital, Larissa
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jrnm.jrnm_27_20

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The term of nutcracker phenomenon describes the entrapment of the left renal vein (LRV) between the superior mesenteric artery and the aorta without accompanying symptoms. The clinical term of nutcracker syndrome corresponds to the additional presence of symptoms. It is a rare anatomical and functional disorder that appears mainly with hematuria and left kidney pain and may be accompanied by albuminuria and pelvic congestion syndrome with varicose veins. It is diagnosed primarily by Doppler ultrasound where the main parameters are the anteroposterior diameter and the flow velocity in the dilated LRV and secondarily by computed tomography where the characteristic finding is the “beak sign” at the site of the stenosis. Therapeutically, surveillance or conservative management is initially chosen due to the high probability of spontaneous remission, while in a persistent and intense clinical picture, the main treatment options are the placement of an endovascular stent and the transposition of the LRV.

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