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Uncracking a Case.

Filipa S Cardoso1, Patrícia S C Alves1, Mário R V Góis1

  • 1Department of Nephrology, Centro Hospitalar Lisboa Central EPE, Hospital Curry Cabral, R. Beneficência 8, Lisboa, Portugal.

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Summary

Nutcracker syndrome (NCS) is a rare condition involving left renal vein compression, often presenting with flank pain and hematuria. Diagnosis can be challenging due to non-specific symptoms, requiring advanced imaging for confirmation.

Keywords:
Hematurialeft renal veinnutcracker syndrome

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Area of Science:

  • Nephrology
  • Vascular Surgery
  • Radiology

Background:

  • Nutcracker phenomenon (NCP) involves left renal vein (LRV) compression, typically between the aorta and superior mesenteric artery.
  • Nutcracker syndrome (NCS) is diagnosed when NCP causes symptoms like flank pain, hematuria, and orthostatic proteinuria.

Observation:

  • A young female presented with flank pain and severe hematuria leading to significant hemoglobin decrease.
  • Initial computed tomography (CT) was unremarkable, but Doppler ultrasound (DUS) later identified NCP.

Findings:

  • Diagnosis of NCS relies on imaging modalities including DUS, CT, MRI, and venography.
  • The case highlights diagnostic challenges due to non-specific symptoms and the need for DUS when CT is negative.

Implications:

  • Management of NCS varies from conservative measures to nephrectomy, based on symptom severity and patient factors.
  • This case underscores the difficulties in diagnosing and managing NCS due to its rarity and lack of standardized treatment protocols.