WordNet

a pattern of symptoms indicative of some disease
a complex of concurrent things; "every word has a syndrome of meanings"
a compound lever used to crack nuts open
speckled birds that feed on nuts

PrepTutorEJDIC

(疾患の徴候となる一群の)症徴候,症候群 / (事件・社会的状態などのパターンを示す)徴候形態
《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）』「2015/05/20 16:21:57」(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. Etiology and evaluation of hematuria in adults
2. 上腸間膜動脈症候群 superior mesenteric artery syndrome
3. 小児における顕微鏡的血尿の評価 evaluation of microscopic hematuria in children
4. 起立性（体位性）蛋白尿症 orthostatic postural proteinuria
5. 腰痛血尿症候群 loin pain hematuria syndrome

English Journal

Left nutcracker syndrome and right ureteropelvic junction obstruction.

Wenwei C1, Xiangzhi Y2, Huazhi X2, Yirong Y3, Chengdi L4.
Asian journal of surgery / Asian Surgical Association.Asian J Surg.2014 Jul;37(3):167-9. doi: 10.1016/j.asjsur.2013.09.010. Epub 2013 Nov 6.
We report a rare case of left nutcracker syndrome and right ureteropelvic junction obstruction in a young woman who suffered flank pain and hematuria. The diagnosis was confirmed with the help of Doppler ultrasonography, retrograde pyelography, magnetic resonance angiography, and magnetic resonance
PMID 24210535

Superior mesenteric artery syndrome - A rare presentation and challenge in spinal cord injury rehabilitation: A case report and literature review.

Desai MH, Gall A, Khoo M.
The journal of spinal cord medicine.J Spinal Cord Med.2014 Jun 29. [Epub ahead of print]
Background Obstruction of the third part of the duodenum (D3) is a very rare cause of gastric outflow obstruction. Rapid weight loss is the biggest risk factor. Patients seen in acute rehabilitation settings, not uncommonly, have a period of rapid weight loss. We report two cases of superior mesente
PMID 24976254

Nutcrackerlike Phenomenon Is An Unusual Cause for Gross Hematuria After a Kidney Graft.

Salehipour M1, Kazemi K, Shamsaeefar A, Hekmati P, Sanaei AK, Bahador A, Aliakbarian M, Malek Hosseini SA.
Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation.Exp Clin Transplant.2014 Jun 9. doi: 10.6002/ect.2013.0260. [Epub ahead of print]
Nutcracker phenomenon is the condition that occurs most commonly at the morphologic type by compression of the left renal vein between the aorta and superior mesenteric artery. The diagnosis is often delayed because of the variability in manifestations and absence of consensus on diagnostic criteria
PMID 24919128

Japanese Journal

下腹部痛を主訴として血尿をきたさないNutcracker syndromeの2例 (第108回成医会第三支部例会)

東京慈恵会医科大学雑誌 126(1), 44-44, 2011-01-15
NAID 120003072809

症例報告ナットクラッカー症候群,腎盂尿管移行部狭窄及び多発腎結石に対し一期的外科治療を施行した1例

上村吉穂,福田護,江川雅之 [他]
日本泌尿器科学会雑誌 102(4), 633-637, 2011-07
NAID 40018897456

「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

「syndrome」

　　[★]

n.

症候群

[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 syndrome