Information about Nutcracker Syndrome
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A picture of a nutcracker. The legs of this nutcracker, with some imagination, could represent the superior mesenteric artery and abdominal aorta in nutcracker syndrome.
Signs and symptoms
The syndrome is associated with hematuria, which can lead to anemia[2], abdominal complaints or pain[3] (classically left flank pain[4]), nausea, and/or vomiting, due to compression of the duodenum which also passes between the SMA and abdominal aorta). Because the left gonad drains via the left renal vein, it can also result in left testicular pain[3] in men or left lower quadrant pain in women.Unusual manifestations of the nutcracker syndrome include varicocele formation and varices in the lower limbs.[5]
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.[6]
Treatment
Treatment depends on the severity and symptoms. Treatments include:- Endovascular stenting.[4]
- Renal vein re-implantation.[7]
- Gonadal vein embolization.[7]
References
1. ^ Sugimoto I, Takashi O, Ishibashi H, Takeuchi N, Nagata Y, Honda Y. Left Renal Vein Entrapment Syndrome (Nutcracker Syndrome) treated with Left Renal Vein Transposition. Jnp J Vasc Surg. 2001 10:503-507. Abstract.
2. ^ Oteki T, Nagase S, Hirayama A, Sugimoto H, Hirayama K, Hattori K, Koyama A. Nutcracker syndrome associated with severe anemia and mild proteinuria. Clin Nephrol. 2004 Jul;62(1):62-5. PMID 15267016.
3. ^ Hilgard P, Oberholzer K, Meyer zum Buschenfelde KH, Hohenfellner R, Gerken G. [The "nutcracker syndrome" of the renal vein (superior mesenteric artery syndrome) as the cause of gastrointestinal complaints] Dtsch Med Wochenschr. 1998 Jul 31;123(31-32):936-40. PMID 9721569.
4. ^ Barnes RW, Fleisher HL 3rd, Redman JF, Smith JW, Harshfield DL, Ferris EJ. Mesoaortic compression of the left renal vein (the so-called nutcracker syndrome): repair by a new stenting procedure. J Vasc Surg. 1988 Oct;8(4):415-21. PMID 3172376
5. ^ Little AF, Lavoipierre AM. Unusual clinical manifestations of the Nutcracker Syndrome. Australasian Radiol. 2002 Jun;46(2):197-200. PMID 12060163.
6. ^ Takebayashi S, Ueki T, Ikeda N, Fujikawa A. Diagnosis of the nutcracker syndrome with color Doppler sonography: correlation with flow patterns on retrograde left renal venography. AJR Am J Roentgenol. 1999 Jan;172(1):39-43. PMID 9888735.
7. ^ Rudloff U, Holmes RJ, Prem JT, Faust GR, Moldwin R, Siegel D. Mesoaortic compression of the left renal vein (nutcracker syndrome): case reports and review of the literature. Ann Vasc Surg. 2006 Jan;20(1):120-9. PMID 16374539.
Ahmed K, Sampath R, Khan MS. Current trends in the diagnosis and management of renal nutcracker syndrome: a review. Eur J Vasc Endovasc Surg. 2006 Apr;31(4):410-6. Epub 2006 Jan 23.
2. ^ Oteki T, Nagase S, Hirayama A, Sugimoto H, Hirayama K, Hattori K, Koyama A. Nutcracker syndrome associated with severe anemia and mild proteinuria. Clin Nephrol. 2004 Jul;62(1):62-5. PMID 15267016.
3. ^ Hilgard P, Oberholzer K, Meyer zum Buschenfelde KH, Hohenfellner R, Gerken G. [The "nutcracker syndrome" of the renal vein (superior mesenteric artery syndrome) as the cause of gastrointestinal complaints] Dtsch Med Wochenschr. 1998 Jul 31;123(31-32):936-40. PMID 9721569.
4. ^ Barnes RW, Fleisher HL 3rd, Redman JF, Smith JW, Harshfield DL, Ferris EJ. Mesoaortic compression of the left renal vein (the so-called nutcracker syndrome): repair by a new stenting procedure. J Vasc Surg. 1988 Oct;8(4):415-21. PMID 3172376
5. ^ Little AF, Lavoipierre AM. Unusual clinical manifestations of the Nutcracker Syndrome. Australasian Radiol. 2002 Jun;46(2):197-200. PMID 12060163.
6. ^ Takebayashi S, Ueki T, Ikeda N, Fujikawa A. Diagnosis of the nutcracker syndrome with color Doppler sonography: correlation with flow patterns on retrograde left renal venography. AJR Am J Roentgenol. 1999 Jan;172(1):39-43. PMID 9888735.
7. ^ Rudloff U, Holmes RJ, Prem JT, Faust GR, Moldwin R, Siegel D. Mesoaortic compression of the left renal vein (nutcracker syndrome): case reports and review of the literature. Ann Vasc Surg. 2006 Jan;20(1):120-9. PMID 16374539.
External links
- Article on nutcracker phenomenon at the New England Journal of Medicine website.
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It directly integrates the Unified Medical Language System.
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Medicine is the science and "" of maintaining and/or restoring human health through the study, diagnosis, and treatment of patients. The term is derived from the Latin ars medicina meaning the art of healing.
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The renal veins are veins that drain the kidney. They connect the kidney to the inferior vena cava.
It is usually singular to each kidney, except in the condition "multiple renal veins".
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It is usually singular to each kidney, except in the condition "multiple renal veins".
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The abdominal aorta is the largest artery in the abdominal cavity. As part of the aorta, it is a direct continuation of descending aorta (of the thorax).
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Path
It begins at the level of the diaphragm, crossing it via the aortic hiatus at the vertebral level of T12...... Click the link for more information.
In human anatomy, the superior mesenteric artery (SMA) arises from the anterior surface of the abdominal aorta, just inferior to the origin of the celiac trunk, and supplies the intestine from the lower part of the duodenum to the left colic flexure and the pancreas.
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In sciences dealing with the anatomy of animals, precise anatomical terms of location are necessary for a variety of reasons. Non-scientists often wonder why zoological and human anatomists use complex terminology to describe locations on a body, when common terms like "up",
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nutcracker consists of a mechanical device for cracking nuts. It works on the principle of moments as described in Archimedes' analysis of the lever. The ballet The Nutcracker derives its name from this festive holiday decoration.
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nut can be either a seed or a fruit.
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Botanical definitions
A nut in botany is a simple dry fruit with one seed (rarely two) in which the ovary wall becomes very hard (stony or woody) at maturity, and where the seed remains unattached or unfused with the..... Click the link for more information.
MeSH D006417 In medicine, hematuria (or "haematuria") is the presence of blood in the urine. It is a sign of a large number of diseases of the kidneys and the urinary tract, ranging from trivial to lethal.
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Anemia
Classification & external resources
ICD-10 D 50. -D 64.
ICD-9 280 - 285
DiseasesDB 663
MedlinePlus 000560
eMedicine med/132 emerg/808 emerg/734
MeSH D000740
Anemia (AmE) or anæmia/anaemia
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Classification & external resources
ICD-10 D 50. -D 64.
ICD-9 280 - 285
DiseasesDB 663
MedlinePlus 000560
eMedicine med/132 emerg/808 emerg/734
MeSH D000740
Anemia (AmE) or anæmia/anaemia
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Abdominal pain
Classifications and external resources
ICD-10 R 10.
ICD-9 789.0
Abdominal pain can be one of the symptoms associated with transient disorders or serious disease.
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Classifications and external resources
ICD-10 R 10.
ICD-9 789.0
Abdominal pain can be one of the symptoms associated with transient disorders or serious disease.
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Nausea
Classifications and external resources
ICD-10 R 11.
ICD-9 787.0
Nausea (Latin: Nausea, Greek: Ναυτεία
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Classifications and external resources
ICD-10 R 11.
ICD-9 787.0
Nausea (Latin: Nausea, Greek: Ναυτεία
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Emesis redirects here. For the genus of metalmark butterflies, see Emesis (butterfly). Heaving redirects here. For the up-and-down motion, see heave.
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In anatomy of the digestive system, the duodenum is a hollow jointed tube about 25-30 cm long connecting the stomach to the jejunum. It is the first and shortest part of the small intestine and it is where most chemical digestion takes place.
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The gonad is the organ that makes gametes. The gonads in males are the testes and the gonads in females are the ovaries. The product, gametes, are haploid germ cells. For example, sperm and egg cells are gametes.
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The renal veins are veins that drain the kidney. They connect the kidney to the inferior vena cava.
It is usually singular to each kidney, except in the condition "multiple renal veins".
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It is usually singular to each kidney, except in the condition "multiple renal veins".
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The testicle (from Latin testis, meaning "witness",[1] plural testes) or ballock is the male generative gland in animals. This article will concentrate on mammalian testicles unless otherwise noted.
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Varicocele is an abnormal enlargement of the veins in the scrotum draining the testicles. The testicular blood vessels originate in the abdomen and course down through the inguinal canal as part of the spermatic cord on their way to the testis.
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Varices in general refers to distended veins. It derives from the Latin word for twisted, "varix". Types of varices include:
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- Varicose veins of lower extremities
- Gastrointestinal varices
- * Esophageal varices
- * Gastric varices
- * Intestinal varices
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Venography (also called phlebography) is a procedure in which an x-ray of the veins, a venogram, is taken after a special dye is injected into the bone marrow or veins.
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gold standard test or criterion standard test is a diagnostic test or benchmark that is regarded as definitive. This can refer to diagnosing a disease process, or the criteria by which scientific evidence is evaluated.
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Computed tomography (CT), originally known as computed axial tomography (CAT or CT scan) and body section roentgenography, is a medical imaging method employing tomography where digital geometry processing is used to generate a three-dimensional image of the
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Medical ultrasonography (sonography) is an ultrasound-based diagnostic imaging technique used to visualize muscles and internal organs, their size, structures and possible pathologies or lesions.
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In medicine, gonadal vein refers to the blood vessel that carrying blood away from the gonad (testis, ovary) toward the heart.
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- Females : ovarian vein
- Males : testicular vein
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Embolization is a non-surgical, minimally-invasive procedure performed by an interventional radiologist and interventional neuroradiologists. It involves the selective occlusion of blood vessels, by purposely introducing emboli.
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The New England Journal of Medicine (New Engl J Med or NEJM) is an English-language peer-reviewed medical journal published by the Massachusetts Medical Society. It is one of the most popular and widely-read peer-reviewed general medical journals in the world.
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