Nutcracker Syndrome: A Rare Cause of Hematuria
Article Sidebar
Main Article Content
Abstract
In pediatrics, hematuria usually responds to benign etiologies. A rare cause is nutcracker syndrome, defined as compression of the left renal vein between the aorta and the superior mesenteric artery, resulting in elevated pressure in the left renal vein with the development of collateral veins and varicose dilatation. The prevalence of this syndrome is unknown. When symptomatic, it causes hematuria, proteinuria, and chronic pelvic pain. At puberty, the rapid growth and development of the vertebral bodies can produce a narrowing of the angle between the aorta and the superior mesenteric artery.
We describe the case of a teenage girl diagnosed with multiple metastatic mucoepithelial carcinoma of bone who presented anemia-producing hematuria. The diagnosis of nutcracker syndrome was arrived at with consideration of the therapeutic options. Finally, with shoe enhancement for scoliosis correction, hematuria was significantly lessened.
Downloads
Article Details
Section
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
How to Cite
References
Kurklinsky AK, Rooke TW. Nutcracker phenomenon and nutcracker syndrome. Mayo Clin Proc. 2010;85(6):552-559. https://doi.org/10.4065/mcp.2009.0586. DOI: https://doi.org/10.4065/mcp.2009.0586
Lau JL, Lo R, Chan FL, et al. The posterior "nutcracker": hematuria secondary to retroaortic left renal vein. Urology. 1986;28(5):437-439. https://doi.org/10.1016/0090-4295(86)90085-3. DOI: https://doi.org/10.1016/0090-4295(86)90085-3
Ozel A, Tufaner O, Kaya E, et al. US and MDCT diagnosis of a rare cause of haematuria in children: posterior nutcracker syndrome. J Ultrasound. 2011;14(2):89-91. https://doi.org/10.1016/j.jus.2011.04.003. DOI: https://doi.org/10.1016/j.jus.2011.04.003
El-Sadr AR, Mina E. Anatomical and surgical aspects in the operative management of varicocele. Urol Cutaneous Rev. 1950;54(5):257-262. DOI: https://doi.org/10.1148/54.2.257
Yih ND, Chyen LH, Cunli Y, et al. Renosplenic shunting in the nutcracker phenomenon: a discussion and paradigm shift in options? A novel approach to treating nutcracker syndrome. Int J Angiol. 2014;23(1):71-76. https://doi.org/10.1055/s-0033-1348883. DOI: https://doi.org/10.1055/s-0033-1348883
Carrasco Hidalgo-Barquero M, de Cea Crespo JM. Hematuria. Protoc Diagn Ter Pediatr. 2014;1:53-68.
Piña J, Saieh C. Hematuria en pediatría. Rev Med Clin CONDES.2009;20(6):904-910.
Santos S, Fernandes L, Ferreira S, et al. Nutcracker syndrome: a cause of hematuria and low back pain in young patients. Cureus. 2022;14(11):e31290. https://doi.org/10.7759/cureus.31290. DOI: https://doi.org/10.7759/cureus.31290
Almuqamam M, Ebrahim M, Nassar G, et al. Atypical posterior nutcracker syndrome in a 17-year-old male without hematuria. Cureus. 2021;13(8):e17221. https://doi.org/10.7759/cureus.17221. DOI: https://doi.org/10.7759/cureus.17221
Ananthan K, Onida S, Davies AH. Nutcracker syndrome: an update on current diagnostic criteria and management guidelines. Eur J Vasc Endovasc Surg. 2017;53(6):886-894. https://doi.org/10.1016/j.ejvs.2017.02.015. DOI: https://doi.org/10.1016/j.ejvs.2017.02.015
Agur AMR, Dalley AF. Grant's Atlas of anatomy, 12th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2009. Chapter 2. Abdomen. p. 158.
Shin JI, Lee JS, Kim MJ. The prevalence, physical characteristics and diagnosis of nutcracker syndrome. Eur J Vasc Endovasc Surg. 2006 Sep;32(3):335-336. https://doi.org/10.1016/j.ejvs.2006.04.030. DOI: https://doi.org/10.1016/j.ejvs.2006.04.030
Bin Dahman HA, Aljabry AO. A case report of a young girl with recurrent hematuria: a missed diagnosis - renal nutcracker syndrome. BMC Nephrol. 2019;20(1):349. https://doi.org/10.1186/s12882-019-1508-6. DOI: https://doi.org/10.1186/s12882-019-1508-6
Korkes F. Nutcracker syndrome: how are we cracking the nuts and whose nuts are we cracking? Int Braz J Urol. 2017;43(4):788-790. https://doi.org/10.1590/S1677-5538.IBJU.2016.0517. DOI: https://doi.org/10.1590/s1677-5538.ibju.2016.0517