The nutcracker phenomenon, also known as nutcracker anatomy or left renal vein entrapment, refers to the anatomic or pathophysiologic entity wherein the superior mesenteric artery compresses and impedes outflow of the left renal vein into the inferior vena cava. It can be a common incidental finding on routine CT imaging and many patients can be asymptomatic 2. If associated with relevant symptoms, it is then known as the nutcracker syndrome.
Cross-sectional imaging demonstrates narrowing of the mesoaortic interval or angle as well as dilatation of the lateral (hilar) aspect of the left renal vein. There may also be dilatation of the gonadal vein with reflux of contrast material.
- 1. Kurklinsky AK, Rooke TW. Nutcracker phenomenon and nutcracker syndrome. (2010) Mayo Clinic proceedings. 85 (6): 552-9. doi:10.4065/mcp.2009.0586 - Pubmed
- 2. Grimm LJ, Engstrom BI, Nelson RC, Kim CY. Incidental detection of nutcracker phenomenon on multidetector CT in an asymptomatic population: prevalence and associated findings. (2013) Journal of computer assisted tomography. 37 (3): 415-8. doi:10.1097/RCT.0b013e3182873235 - Pubmed
- 3. Hangge, Patrick, Gupta, Nikhil, Khurana, Aditya, Quencer, Keith, Albadawi, Hassan, Alzubaidi, Sadeer, Knuttinen, M-Grace, Naidu, Sailendra, Oklu, Rahmi. Degree of Left Renal Vein Compression Predicts Nutcracker Syndrome. (2018) Journal of Clinical Medicine. 7 (5): 107. doi:10.3390/jcm7050107