Limits...
Mixed nutcracker syndrome with left renal vein duplication: A severe and exceptional presentation in an 18-year-old boy.

Mallat F, Hmida W, Othmen MB, Mosbah F - Urol Ann (2015 Apr-Jun)

Bottom Line: Ultimately it may be associated with substantial morbidity and even life-threatening events.Our purpose is to raise clinician's awareness for this condition so that they will be more likely to diagnose it.This will facilitate prompt diagnosis and treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Hospital of Sahloul, Sousse, Tunisia.

ABSTRACT
The nutcracker syndrome (NCS) is rare and often misdiagnosed because it embraces an extended non-pathognomonic spectrum of symptoms that imply a difficult diagnosis. Ultimately it may be associated with substantial morbidity and even life-threatening events. Mixed NCS with renal vein duplication is an exceptional variety, have previously been reported to the best of our knowledge. We report a rare case of an 18-year-old boy who presented with a long history of abdominal, pelvic and left flank pain, fatigue and higher bilateral varicocele. Computed tomographic angiography, Doppler ultrasonography and venography were performed revealed left renal vein duplication with dilated retroaortic and preaortic branchs, entrapped respectively between the aorta and the vertebral column and in the aortico-mesenteric space, with extensive and complex varices of the deep pelvic venous plexus; promoting the mixed renal NCS. Auto transplantation of the left kidney was suggested, but refused by the patient; and only the varicocele was managed. The patient is still suffering from his severe initial symptoms. Diagnosis is difficult and should be considered in patients with inexplicable flank or abdominal pain. Our purpose is to raise clinician's awareness for this condition so that they will be more likely to diagnose it. This will facilitate prompt diagnosis and treatment.

No MeSH data available.


Related in: MedlinePlus

Computed tomographic angiography demonstrated the acute angle between the aorta and superior mesenteric artery at 12°; and showed the retroaortic and the preoaortic branchs, entrapped respectively between the aorta and the vertebral column, and between the abdominal aorta and the superior mesenteric artery
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4374268&req=5

Figure 4: Computed tomographic angiography demonstrated the acute angle between the aorta and superior mesenteric artery at 12°; and showed the retroaortic and the preoaortic branchs, entrapped respectively between the aorta and the vertebral column, and between the abdominal aorta and the superior mesenteric artery

Mentions: Computed tomographic angiography (CTA) was performed revealed LRV duplication with dilated retroaortic and preoaortic branchs, entrapped respectively between the aorta and the vertebral column and in the aortico-mesenteric space. The post-anterior diameter of the hilar portion and that of the aortico-mesenteric and aortico-vertebral stenotic portions of the LRV were 9.8 mm and 1.7 mm and 11 mm and 8 mm, respectively. The promoting the anterior and posterior renal NCS [Figures 1–4].


Mixed nutcracker syndrome with left renal vein duplication: A severe and exceptional presentation in an 18-year-old boy.

Mallat F, Hmida W, Othmen MB, Mosbah F - Urol Ann (2015 Apr-Jun)

Computed tomographic angiography demonstrated the acute angle between the aorta and superior mesenteric artery at 12°; and showed the retroaortic and the preoaortic branchs, entrapped respectively between the aorta and the vertebral column, and between the abdominal aorta and the superior mesenteric artery
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4374268&req=5

Figure 4: Computed tomographic angiography demonstrated the acute angle between the aorta and superior mesenteric artery at 12°; and showed the retroaortic and the preoaortic branchs, entrapped respectively between the aorta and the vertebral column, and between the abdominal aorta and the superior mesenteric artery
Mentions: Computed tomographic angiography (CTA) was performed revealed LRV duplication with dilated retroaortic and preoaortic branchs, entrapped respectively between the aorta and the vertebral column and in the aortico-mesenteric space. The post-anterior diameter of the hilar portion and that of the aortico-mesenteric and aortico-vertebral stenotic portions of the LRV were 9.8 mm and 1.7 mm and 11 mm and 8 mm, respectively. The promoting the anterior and posterior renal NCS [Figures 1–4].

Bottom Line: Ultimately it may be associated with substantial morbidity and even life-threatening events.Our purpose is to raise clinician's awareness for this condition so that they will be more likely to diagnose it.This will facilitate prompt diagnosis and treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Hospital of Sahloul, Sousse, Tunisia.

ABSTRACT
The nutcracker syndrome (NCS) is rare and often misdiagnosed because it embraces an extended non-pathognomonic spectrum of symptoms that imply a difficult diagnosis. Ultimately it may be associated with substantial morbidity and even life-threatening events. Mixed NCS with renal vein duplication is an exceptional variety, have previously been reported to the best of our knowledge. We report a rare case of an 18-year-old boy who presented with a long history of abdominal, pelvic and left flank pain, fatigue and higher bilateral varicocele. Computed tomographic angiography, Doppler ultrasonography and venography were performed revealed left renal vein duplication with dilated retroaortic and preaortic branchs, entrapped respectively between the aorta and the vertebral column and in the aortico-mesenteric space, with extensive and complex varices of the deep pelvic venous plexus; promoting the mixed renal NCS. Auto transplantation of the left kidney was suggested, but refused by the patient; and only the varicocele was managed. The patient is still suffering from his severe initial symptoms. Diagnosis is difficult and should be considered in patients with inexplicable flank or abdominal pain. Our purpose is to raise clinician's awareness for this condition so that they will be more likely to diagnose it. This will facilitate prompt diagnosis and treatment.

No MeSH data available.


Related in: MedlinePlus