Nutcracker syndrome – a rare cause of hematuria
General Medicine, 2023, 25(4), 61-64.
K. I. Koleva-Venkova1, A. L. Varlyakov1, M. B. Penkov1, I. K. Kalinkova2, A. I. Kundurdjiev2, D. K. Genov2, I. A. Parvova3, R. Gancheva3, R. T. Stoychev4, I. P. Martinov4, Y. D. Vlahov5, M.K. Nikolova2
1 Clinic of Imaging Studies, University Hospital „Sv. Ivan Rilski“, Medical University ‒ Sofia
2 Clinic of Nephrology, University Hospital „Sv. Ivan Rilski“, Medical University ‒ Sofia
3 Clinic of Rheumatology, University Hospital „Sv. Ivan Rilski“, Medical University ‒ Sofia
4 Clinic of Vascular Surgery, University Hospital Pirogov, Medical University ‒ Sofia
5 Clinic of Endocrinology and Metabolic Diseases, University Hospital Sofiamed, Medical Faculty, Sofia University “Sv. Kl. Ohridski” – Sofia
Abstract. Nutcracker syndrome is a rare inborn vascular abnormality in which the left renal vein is trapped and compressed between the superior mesenteric artery and the aorta. Compression leads to congestion and dilation of the left renal vein, erythrocyturia with or without proteinuria, pelvic congestion and pelvic pain in women and varicocele and/or swelling of the left testicle in men. The affected individuals may report low abdominal pain and discomfort in the left flank. The diagnosis is based on imaging studies (abdominal ultrasound, computed tomography with contrast enhancement, angiography, magnetic resonance imaging). Nutcracker syndrome is part of the differential diagnosis of hematuria and pelvic pain. The treatment is interventional (percutaneous transluminal angioplasty of the left renal vein) or surgical. The authors present a 46-year-old female patient with nutcracker syndrome diagnosed using contrast-enhanced computed tomography for hematuria since childhood.
Key words: nutcracker syndrome, hematuria, imaging studies, computed tomography
Address for correspondence: Assoc. prof. M. Nikolova, MD, PhD, е-mail: milena_i_dani@abv.bg