WordNet

any state or process known through the senses rather than by intuition or reasoning
a remarkable development
a compound lever used to crack nuts open
speckled birds that feed on nuts

PrepTutorEJDIC

『現象』 / 驚くべきこと(物),非凡な人
《しばしば複数形で》クルミ割り / ホシガラス(とがった口ばしのカラス科の鳥)

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/08/04 14:59:05」(JST)

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Compression of the left renal vein (marked by the arrow) between the superior mesenteric artery (above) and the aorta (below) due to nutcracker syndrome.

Thrombosis in the left renal vein associated with dilation.

A nutcracker. The legs of this nutcracker, with some imagination, could represent the superior mesenteric artery and abdominal aorta in nutcracker syndrome.

In medicine, the nutcracker syndrome (NCS) — is a clinically manifest variant of nutcracker phenomenon, renal vein entrapment syndrome, or mesoaortic compression of the left renal vein. It results most commonly from the compression of the left renal vein between the abdominal aorta (AA) and superior mesenteric artery (SMA), although other variants exist.^[1]^[2] The name derives from the fact that, in the sagittal plane and/or transverse plane, the SMA and AA (with some imagination) appear to be a nutcracker crushing a nut (the renal vein). There is a wide spectrum of clinical presentations and diagnostic criteria are not well defined, which frequently results in delayed or incorrect diagnosis.^[1] This condition is not to be confused with superior mesenteric artery syndrome, which is the compression of the third portion of the duodenum by the SMA and the AA.

Signs and symptoms

NCS is associated with hematuria (which can lead to anemia)^[3] and abdominal pain (classically left flank or pelvic pain).^[4]

Since the left gonad drains via the left renal vein it can also result in left testicular pain^[5] in men or left lower quadrant pain in women. Nausea and vomiting can result due to compression of the splanchnic veins.^[5] An unusual manifestation of NCS includes varicocele formation and varicose veins in the lower limbs.^[6] Another clinical study has shown that nutcracker syndrome is a frequent finding in varicocele-affected patients and possibly, nutcracker syndrome should be routinely excluded as a possible cause of varicocele and pelvic congestion.^[7]

Diagnosis

Nutcracker syndrome can be diagnosed with:

Left renal venography — considered to be the gold standard test.
Computed tomography (CT).
Abdominal ultrasonography — not definitive but has been found to be useful.^[8]

Differential diagnosis

Pelvic Congestion Syndrome
Renal stones
Genitourinary malignancy
Loin pain hematuria syndrome^[9]

Treatment

Treatment depends on the severity and symptoms. Treatments include:

Endovascular stenting.^[4]
Renal vein re-implantation.^[10]
Gonadal vein embolization.^[10]

References

^ ^a ^b Kurklinsky A., Rooke T. (June 2010). "Nutcracker Phenomenon and Nutcracker Syndrome". Mayo Clin Proc. 85 (6): 552–559. doi:10.4065/mcp.2009.0586. PMC 2878259. PMID 20511485.
^ Sugimoto I, Takashi O, Ishibashi H, Takeuchi N, Nagata Y, Honda Y (2001). "Left Renal Vein Entrapment Syndrome (Nutcracker Syndrome) treated with Left Renal Vein Transposition". Jnp J Vasc Surg. 10: 503–7. ^{[dead link]}
^ Oteki T, Nagase S, Hirayama A et al. (July 2004). "Nutcracker syndrome associated with severe anemia and mild proteinuria". Clin. Nephrol. 62 (1): 62–5. PMID 15267016.
^ ^a ^b Barnes RW, Fleisher HL, Redman JF, Smith JW, Harshfield DL, Ferris EJ (October 1988). "Mesoaortic compression of the left renal vein (the so-called nutcracker syndrome): repair by a new stenting procedure". J. Vasc. Surg. 8 (4): 415–21. doi:10.1067/mva.1988.avs0080415. PMID 3172376.
^ ^a ^b Hilgard P, Oberholzer K, Meyer zum Büschenfelde KH, Hohenfellner R, Gerken G (July 1998). "[The "nutcracker syndrome" of the renal vein (superior mesenteric artery syndrome) as the cause of gastrointestinal complaints]". Dtsch. Med. Wochenschr. (in German) 123 (31–32): 936–40. doi:10.1055/s-2007-1024101. PMID 9721569.
^ Little AF, Lavoipierre AM (June 2002). "Unusual clinical manifestations of the Nutcracker Syndrome". Australas Radiol 46 (2): 197–200. doi:10.1046/j.1440-1673.2001.01037.x. PMID 12060163.
^ Mohamadi A, Ghasemi-Rad M, Mladkova N, Masudi S. (August 2010). "Varicocele and nutcracker syndrome: sonographic findings". J Ultrasound Med 29 (8): 1153–1160. PMID 20660448.
^ Takebayashi S, Ueki T, Ikeda N, Fujikawa A (January 1999). "Diagnosis of the nutcracker syndrome with color Doppler sonography: correlation with flow patterns on retrograde left renal venography". AJR Am J Roentgenol 172 (1): 39–43. doi:10.2214/ajr.172.1.9888735. PMID 9888735.
^ Ahmed K, Sampath R, Khan MS (2006). "Current trends in the diagnosis and management of renal nutcracker syndrome: a review". Eur J Vasc Endovasc Surg 31 (4): 410–6. doi:10.1016/j.ejvs.2005.05.045. PMID 16431142.
^ ^a ^b Rudloff U, Holmes RJ, Prem JT, Faust GR, Moldwin R, Siegel D (January 2006). "Mesoaortic compression of the left renal vein (nutcracker syndrome): case reports and review of the literature". Ann Vasc Surg 20 (1): 120–9. doi:10.1007/s10016-005-5016-8. PMID 16374539.

External links

Kimura K, Araki T (July 1996). "Images in clinical medicine. Nutcracker phenomenon". N. Engl. J. Med. 335 (3): 171. doi:10.1056/NEJM199607183350305. PMID 8657215.

UpToDate Contents

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1. びまん性食道けいれん、くるみ割り食道、および下部食道括約筋圧亢進症 diffuse esophageal spasm nutcracker esophagus and hypertensive lower esophageal sphincter
2. 成人における血尿の原因および評価 etiology and evaluation of hematuria in adults
3. 上腸間膜動脈症候群 superior mesenteric artery syndrome
4. 小児における顕微鏡的血尿の評価 evaluation of microscopic hematuria in children
5. 高解像度食道内圧検査 high resolution manometry

English Journal

Discriminating renal nutcracker syndrome from asymptomatic nutcracker phenomenon using multidetector computed tomography.

Yun SJ1,2, Lee JM2, Nam DH3, Ryu JK2, Lee SH4.
Abdominal radiology (New York).Abdom Radiol (NY).2016 May 24. [Epub ahead of print]
PURPOSE: To retrospectively evaluate the ability of computed tomographic (CT) findings to discriminate nutcracker syndrome (NCS) from asymptomatic nutcracker phenomenon (NCP) and to investigate the diagnostic value of CT findings in diagnosis of NCS.METHODS: From January 2014 to April 2015, 216 pati
PMID 27221972

Robotic-Assisted Laparoscopic Donor Nephrectomy of Patient With Nutcracker Phenomenon.

Barman N1, Palese M.
Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation.Exp Clin Transplant.2016 May 17. doi: 10.6002/ect.2015.0335. [Epub ahead of print]
We report the case of a 30-year-old male patient undergoing a robotic-assisted laparoscopic left donor nephrectomy, where compression of the left renal vein between the superior mesenteric artery and aorta was noted on magnetic resonance angiography before the operation. The patient was diagnosed wi
PMID 27210521

Examining the aetiopathogenesis of varicoceles: the relationship between retroperitoneal adipose tissue and testicular venous drainage.

Umul M1, Değirmenci B2, Umul A2, Uçar M1, Yılmaz Ö2, Altok M1, Güneş M1, Orhan H3, Serel TA1.
Andrologia.Andrologia.2016 Apr;48(3):293-9. doi: 10.1111/and.12446. Epub 2015 Jun 18.
This study evaluated the effect of retroperitoneal adipose tissue on testicular venous drainage and tested the nutcracker phenomenon by clinical and imaging findings. A total of 95 patients were included. The patients were evaluated with a detailed medical history and physical examination for varico
PMID 26085083

Japanese Journal

精索静脈瘤破裂を来たしたナットクラッカー現象に対し自家腎移植を施行した1例

竹澤健太郎,中澤成晃,米田傑 [他]
泌尿器科紀要 57(4), 213-216, 2011-04
… A diagnosis of varicocele rupture secondary to nutcracker phenomenon was made. … Surgical intervention to treat nutcracker phenomenon is considered controversial. … We believe that our procedure is a reliable option for surgical treatment for nutcracker phenomenon. …
NAID 120003072111

Nutcracker phenomenon : A new diagnostic method of multislice computed tomography angiography

FU WEI-JUN,HONG BAO-FA,GAO JIANG-PING,XIAO YUE-YONG,YANG YONG,CAI WEI,GUO GANG,WANG XIAO XIONG
International journal of urology 13(7), 870-873, 2006-07-01
NAID 10018173107

「ナットクラッカー現象」

Nutcracker syndrome
	The nutcracker syndrome results from compression of the left renal vein between the aorta and the superior mesenteric artery.
Classification and external resources
DiseasesDB	32367

　　[★]

英: nutcracker phenomenon
同: nutcracker現象ナッツクラッカー現象、ナットクラッカー症候群 nutcracker syndrome、くるみ割り現象、left renal vein entrapment, left renal vein hypertension

[show details]

ナットクラッカー現象 : 約 9,330 件
ナッツクラッカー現象 : 約 62 件

左腎静脈は腹部大動脈と上腸間膜動脈の間を走るため，この間に左腎静脈が挟まれてうっ血。血尿
この時の血尿は腎血管に由来するらしい？そのため、赤血球の変形はみられないとか。

症状

左腎の肉眼的血尿、左側の側腹部痛、左側の精巣または卵巣静脈瘤

タンパク尿はない？

参考

http://en.wikipedia.org/wiki/Nutcracker_syndrome

「phenomenon」

　　[★]

n.

現象、事象

関: consequence、event、phenomena、phenomenal

[Kurklinsky-1] Kurklinsky A., Rooke T. (June 2010). "Nutcracker Phenomenon and Nutcracker Syndrome". Mayo Clin Proc. 85 (6): 552–559. doi:10.4065/mcp.2009.0586. PMC 2878259. PMID 20511485.

[2] Sugimoto I, Takashi O, Ishibashi H, Takeuchi N, Nagata Y, Honda Y (2001). "Left Renal Vein Entrapment Syndrome (Nutcracker Syndrome) treated with Left Renal Vein Transposition". Jnp J Vasc Surg. 10: 503–7. ^{[dead link]}

[3] Oteki T, Nagase S, Hirayama A et al. (July 2004). "Nutcracker syndrome associated with severe anemia and mild proteinuria". Clin. Nephrol. 62 (1): 62–5. PMID 15267016.

[barnes_3172376-4] Barnes RW, Fleisher HL, Redman JF, Smith JW, Harshfield DL, Ferris EJ (October 1988). "Mesoaortic compression of the left renal vein (the so-called nutcracker syndrome): repair by a new stenting procedure". J. Vasc. Surg. 8 (4): 415–21. doi:10.1067/mva.1988.avs0080415. PMID 3172376.

[hilgard_9721569-5] Hilgard P, Oberholzer K, Meyer zum Büschenfelde KH, Hohenfellner R, Gerken G (July 1998). "[The "nutcracker syndrome" of the renal vein (superior mesenteric artery syndrome) as the cause of gastrointestinal complaints]". Dtsch. Med. Wochenschr. (in German) 123 (31–32): 936–40. doi:10.1055/s-2007-1024101. PMID 9721569.

[6] Little AF, Lavoipierre AM (June 2002). "Unusual clinical manifestations of the Nutcracker Syndrome". Australas Radiol 46 (2): 197–200. doi:10.1046/j.1440-1673.2001.01037.x. PMID 12060163.

[7] Mohamadi A, Ghasemi-Rad M, Mladkova N, Masudi S. (August 2010). "Varicocele and nutcracker syndrome: sonographic findings". J Ultrasound Med 29 (8): 1153–1160. PMID 20660448.

[8] Takebayashi S, Ueki T, Ikeda N, Fujikawa A (January 1999). "Diagnosis of the nutcracker syndrome with color Doppler sonography: correlation with flow patterns on retrograde left renal venography". AJR Am J Roentgenol 172 (1): 39–43. doi:10.2214/ajr.172.1.9888735. PMID 9888735.

[9] Ahmed K, Sampath R, Khan MS (2006). "Current trends in the diagnosis and management of renal nutcracker syndrome: a review". Eur J Vasc Endovasc Surg 31 (4): 410–6. doi:10.1016/j.ejvs.2005.05.045. PMID 16431142.

[rudloff_16374539-10] Rudloff U, Holmes RJ, Prem JT, Faust GR, Moldwin R, Siegel D (January 2006). "Mesoaortic compression of the left renal vein (nutcracker syndrome): case reports and review of the literature". Ann Vasc Surg 20 (1): 120–9. doi:10.1007/s10016-005-5016-8. PMID 16374539.

匿名

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案内

案内

nutcracker phenomenon