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Nutcracker Syndrome, vascular imaging with ultrasound
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
2018 (English)In: Cardiovasc Pharm Open Access, ISSN 2329-6607, Vol. 7, no 2, article id 1000235Article in journal (Refereed) Published
Abstract [en]

Nutcracker Syndrome (NCS) or Left Renal Vein (LRV) entrapment is rare and may be caused by compression of the vein between the aorta and the Superior Mesenteric Artery (SMA). LRV hypertension may lead to varicosities. The syndrome is characterized by a complex of symptoms with substantial variations, the diagnosis is difficult and therefor often delayed. The diagnosis may be settled by many imaging methods, such as renal angiography, retrograde phlebography, Computed Tomography (CT), Magnetic Resonance Imaging (MRI) and Doppler Ultrasonography (DUS). The degree of stenosis may be detected measuring Doppler flow velocities by DUS.

A 50-year old female with Crohn´s disease treated by ileocecal resection, performed 20 years ago, and symptomatic epilepsy treated by a vagal stimulator, had newly added symptoms of abdominal pain, weight loss, dizziness, irregular bowel movements, and increasing fatigue. Blood parameters and physical examination were normal. CT showed no signs of active Crohn´s disease. The left renal veins and the left ovarian vein were dilated and the aorto-mesenteric angle was only 22 degrees.

DUS (Siemens S2000, 6 and 9 MHz transducers) performed one month later confirmed the findings of the CT with typical findings of NCS. DUS will play a crucial role in Nutcracker syndrome considering flow velocity, diameter measurement, anatomy and aorto-mesenteric angle. DUS is a non-invasive, cheap modality that gives a very good resolution that can define vessel walls and evaluate flow velocity conditions. This patient had mild symptoms that led to a conservative treatment whereas epilepsy and Crohn ́s disease was the main problem. If severe symptoms occur different kinds of treatments are available, such as stenting of LRV, open surgical interventions, ablation of collateral pelvic veins and coil embolization.

Place, publisher, year, edition, pages
Los Angeles, CA, United States: Omics Publishing Group , 2018. Vol. 7, no 2, article id 1000235
Keywords [en]
Vascular; Nutcracker syndrome; Anatomy; Cardiovascular
National Category
Medical and Health Sciences Radiology, Nuclear Medicine and Medical Imaging
Identifiers
URN: urn:nbn:se:liu:diva-152728DOI: 10.4172/2329-6607.1000235OAI: oai:DiVA.org:liu-152728DiVA, id: diva2:1263901
Available from: 2018-11-18 Created: 2018-11-18 Last updated: 2019-11-11Bibliographically approved

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Zachrisson, Helene

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