A systematic review on nutcracker syndrome and proposed diagnostic algorithm

Area of Science:

• Vascular Medicine
• Nephrology
• Radiology

Background:

• Nutcracker syndrome (NCS) is a venous compressive disease with diverse clinical presentations and imaging findings, complicating diagnosis.
• Accurate diagnosis of NCS is crucial for managing debilitating symptoms.

Purpose of the Study:

• To systematically review diagnostic criteria for Nutcracker syndrome (NCS).
• To propose a comprehensive framework for clinical decision-making in NCS diagnosis.

Main Methods:

• Systematic review of observational studies and case series within the last 10 years.
• Extraction and synthesis of data on clinical features, demographics, and radiologic criteria for NCS.
• Development of a diagnostic framework based on synthesized findings.

Main Results:

• 14 studies and 384 patients with NCS were included.
• Common symptoms include hematuria (69.5%), left flank/abdominal pain (48.4%), pelvic pain (23.1%), and varicocele (15.8%).
• Ultrasound and CT were common, with >80% left renal vein stenosis frequently used; venography with pressure gradient measurement is key for intervention candidates.

Conclusions:

• Nutcracker syndrome (NCS) diagnosis and management are challenging.
• A comprehensive diagnostic framework integrating clinical evaluation, imaging (ultrasound, CT/MRI), and venography is proposed to aid clinical decision-making.