Nutcracker phenomenon

Case contributed by Dr Safwat Mohammad Almoghazy

Presentation

A case of buccal mucosal cancer treated by surgery then radiotherapy on follow-up.

Patient Data

Age: 70 years
Gender: Male
CT

Evidence of compression effect of the left renal vein between the superior mesenteric artery (SMA) and aorta with reduced aortic-SMA angle about 35° (the normal angle is approximately 45° (38-65°) with subsequent multiple collateral pathways at the renal hilum: main collateral pathway is the left gonadal vein which will display early enhancement during portal venous phase, suggestive of Nutcracker Phenomenon  for clinical correlation to rule out Nutcracker syndrome . 

Calcified atherosclerotic changes are seen in the visualized aorta and its major branches.

The penile prosthesis is noted 

No other gross abnormality detected.

Photo

It derives its name from the action of a nutcracker which can open a nut by cracking the shell by compressing it between the two handles.

Case Discussion

Incidentally noted compression effect of the left renal vein between the superior mesenteric artery (SMA) and aorta with a reduced aortic-SMA angle about 35° with subsequent multiple collateral pathways at the renal hilum are seen. 

Nutcracker sign is a vascular compression disorder and refers to the compression of the left renal vein between the superior mesenteric artery (SMA) and aorta. This can lead to renal venous hypertension, resulting in rupture of thin-walled veins into the collecting system with resultant haematuria which forming Nutcracker syndrome. 

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Case information

rID: 51924
Case created: 14th Mar 2017
Last edited: 12th Jun 2017
System: Vascular
Inclusion in quiz mode: Included

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