Pediatric Nutcracker Syndrome

  • Etiology:
    — Compression of left renal vein between superior mesenteric artery and aorta (most common)
    — Compression of retroaortic left renal vein between aorta and vertebral body
  • Imaging:
    — Stenosis of proximal left renal vein with associated dilation of distal left renal vein
    — Dilation of left gonadal vein collaterals
  • DDX:
  • Complications: Renal vein thrombosis
  • Treatment: Surgical
  • Clinical: Presentation is left flank pain or pelvic pain and hematuria from left ureteral orifice

Radiology Cases of Nutcracker Syndrome

US and CT of nutcracker syndrome
Transverse US of the abdomen (above) shows just to the left of midline compression of the left renal vein beween the superior mesenteric artery and aorta resulting in dilation of the proximal left renal vein. Axial CT with contrast of the abdomen (below) shows this more clearly.
CT of nutcracker syndrome
Axial CT with contrast of the abdomen shows stenosis of the proximal left renal vein with associated dilation of the distal left renal vein due to compression of the left renal vein between the superior mesenteric artery and aorta. There were no gonadal collaterals