Under false flag-the so-called nutcracker syndrome
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Thomas Scholbach

Praxis für spezielle Ultraschalldiagnostik, Rödelstraße 24, 04229 Leipzig, Telefon: 0341/6880219; E-Mail: praxis.scholbach@posteo.de

Wilhelm Sandmann

Sektion Gefäßchirurgie, Clinic Bel Etage, Prof. em. für Chirurgie und Gefäßchirurgie, ehem. Direktor der Klinik für Gefäßchirurgie und Nierentransplantation, Heinrich – Heine Univ. Düsseldorf w.sandmann@gmx.de

 

Abstract

 

The compression of the left renal vein at the crossing with the midline by the aorta or the right renal artery is an underdiagnosed condition usually described as nutcracker syndrome. The underlying cause in the mainly female patients is an increased lumbar lordosis shifting the aorta ventrally thus stretching and compressing the left renal vein. The contribution of the superior mesenteric artery is rarely significant. To enhance its comprehension, we thus coined the term lordogenetic left renal vein compression.

The clinical symptoms consist of left-sided pain in the flank, hypochondrium, back and head as well as post-prandial pain in the left upper abdomen. A thorough and detailed colour Doppler sonographic examination is our diagnostic method of choice. We quantify collateral pathways with the PixelFlux-technique and operate by prolongation of the left renal vein or external PTFE shielding of the left renal vein.

Keywords: nutcracker syndrome; lordogenetic renal vein compression; color duplex sonography; perfusion quantification; functional diagnosis. EHLERS-DANLOS Syndrome

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