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Evaluation of posterior nutcracker phenomenon using multisection spiral CT.

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|September 19, 2018
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Posterior nutcracker phenomenon (PNP), a rare left renal vein entrapment, was identified in 2.06% of patients via multisection spiral computed tomography (MSCT). This imaging technique and associated measurements aid in diagnosing this potentially underdiagnosed condition.

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Area of Science:

  • Radiology
  • Vascular Anatomy
  • Urology

Background:

  • Posterior nutcracker phenomenon (PNP) is a rare form of left renal vein entrapment.
  • It may be underdiagnosed due to its infrequent occurrence.

Purpose of the Study:

  • To evaluate the epidemiology, anatomical classification, clinical significance, and radiological features of PNP.
  • To assess the diagnostic utility of multisection spiral computed tomography (MSCT) in identifying PNP.

Main Methods:

  • Retrospective analysis of 6,225 patients who underwent abdominal enhanced MSCT.
  • Assessment of renal vein diameter, vessel compression ratio, proteinuria, hematuria, and clinical symptoms.

Main Results:

  • PNP was observed in 2.06% of patients, with variations in left renal vein involvement.
  • The prevalence of posterior nutcracker syndrome (PNS) within PNP cases was 17.2%.
  • Significant differences in measured values were noted between symptomatic PNS and asymptomatic PNP (aPNP), particularly in type II abnormalities.

Conclusions:

  • PNP is an uncommon condition involving left renal vein entrapment.
  • MSCT is a valuable tool for the diagnosis and recognition of PNP.
  • Further recognition of PNP is crucial due to its potential for underdiagnosis.