Clinico-radiological correlation of nutcracker syndrome: a single centre experience

Area of Science:

• Nephrology
• Vascular Surgery
• Pediatric Urology

Background:

• Nutcracker syndrome (NS) is caused by left renal vein compression between the aorta and superior mesenteric artery (SMA).
• Symptoms range from asymptomatic hematuria to severe pelvic congestion, impacting patient quality of life.

Purpose of the Study:

• To evaluate clinical characteristics of pediatric patients diagnosed with NS.
• To correlate clinical and laboratory findings with Doppler sonographic measurements for improved diagnostic accuracy.

Main Methods:

• A retrospective study of 63 pediatric patients (19 boys, 44 girls) diagnosed with NS between January 2004 and January 2014.
• Doppler sonography was used to measure SMA angles in supine and upright positions.
• Clinical data, including hematuria and proteinuria, were analyzed alongside sonographic findings.

Main Results:

• Nine out of 63 patients experienced resolution of hematuria and proteinuria during follow-up.
• These nine patients demonstrated a statistically significant difference in upright SMA angles (p=0.035).
• Doppler sonography proved to be a non-invasive diagnostic tool for NS.

Conclusions:

• Upright SMA angle measurement is more effective than supine measurement for clinicoradiological correlation in NS.
• Doppler sonography is a valuable non-invasive method for diagnosing nutcracker syndrome.
• Specific SMA angle changes may predict symptom resolution in pediatric NS patients.