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Query: UMLS:C0016199 (flank pain)
 2,189 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Compression of the left renal vein (LRV) between the superior mesenteric artery and the aorta has been termed the nutcracker syndrome. Although often asymptomatic, this syndrome may result in varicocele, ovarian vein syndrome, and rarely LRV hypertension, pelviureteral varices, hematuria, and flank pain. Previous surgical approaches have included nephrectomy, variceal ligation, nephropexy, or renocaval reimplantation. We report a new LRV stenting procedure that provided relief for a young woman incapacitated by daily left flank pain and microscopic hematuria. Phlebography of the LRV revealed mesoaortic compression associated with a pressure gradient of 12 mm Hg and preferential outflow down large pelviureteral varices. At operation compression of the LRV was corrected with an external stent of reinforced polytetrafluoroethylene. The patient was asymptomatic and free of hematuria for 9 months after operation and follow-up phlebography documented normal renocaval flow, elimination of the pressure gradient, and reduction of the pelviureteral varices. This represents the first description in the vascular surgical literature of this venous compression syndrome, which has been recognized in previous urologic and radiologic reports reviewed herein. Vascular surgeons should be cognizant of the nutcracker syndrome, and we recommend this new stenting procedure as a more simple and physiologic therapy than previous approaches to this problem.
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PMID:Mesoaortic compression of the left renal vein (the so-called nutcracker syndrome): repair by a new stenting procedure. 317 76

We report a case of aorto-left renal vein fistula secondary to an aortic aneurysm presenting with flank pain, a left-sided varicocoele and microscopic haematuria. These symptoms and signs should alert the clinician to this rare complication of abdominal aortic aneurysm.
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PMID:Rupture of an aortic aneurysm into the renal vein presenting as a left-sided varicocoele. Case report. 367 60

The treatment of varicocele is controversial in boys and it is a contributing factor to male infertility. Recently it has been proposed that early therapy of a varicocele during childhood or adolescence may improve the prognosis of fertility. The authors review their experience with the diagnosis and management of left varicocele in 20 pediatric patients 6 to 15 years old. All were managed under local anesthesia by spermatic venography and percutaneous transcatheter embolization of the internal spermatic vein with spring coils. All achieved satisfactory occlusion, and during the follow-up, from 13 years to 9 months, there was only one recurrence, noted in a patient 6 months after the procedure. Complications were phlebitis of the pampiniform plexus, leading to swelling and erythema of the left scrotum, and mild flank pain; these symptoms resolved without sequelae. This is a safe and effective nonsurgical method of obliterating varicoceles in children, with a low morbidity rate and a short hospital stay.
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PMID:Percutaneous venography and embolization of the internal spermatic vein by spring coil for treatment of the left varicocele in children. 759 25

The treatment of varicocele is controversial in boys and it is a contributing factor to male infertility. Recently it has been proposed that earlier therapy of a varicocele during this period may improve the prognosis of infertility. We review our experience with the diagnosis and management of left varicocele in 30 pediatric patients 6 to 15 years old. All patients had clinically palpable varicocele. All were managed under local anesthesia by spermatic venography and percutaneous transcatheter embolization of the internal spermatic vein with spring coils. All achieved satisfactory occlusion, and during the follow up from 13 years to 9 months there was only one recurrence, noted in a patient 6 months after the procedure. Internal spermatic venograms allowed precise coil placement relative to collateral veins which could cause recurrence. Complications developed were phlebitis of the pampiniform plexus, leading to swelling and erythema of the left scrotum and mild flank pain, these symptoms resolved without sequelae. This a safe and effective nonsurgical method of obliterating varicoceles in children.
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PMID:[Venography and percutaneous embolization of the spermatic vein with spring coil as treatment of the varicocele in childhood]. 852 17

Since its description in 1972, the Nutcracker Syndrome or Aorto-Mesenteric Left Renal Vein Entrapment Syndrome has been mentioned in the literature as an infrequent cause of hematuria originating from the left collecting system. It describes compression of the left renal vein in the fork between the abdominal aorta and the proximal Superior Mesenteric Artery (SMA), close to its origin. This results in left renal venous hypertension leading to the development of collateral veins with intrarenal and perirenal varicosities which can cause hematuria if the thin-walled septum separating the veins from the collecting system ruptures. The main presenting symptom is hematuria, with or without left flank pain. Some patients may present with left flank pain alone and, in a few, varicocele might be the only complaint. Exercise seems to aggravate the symptoms. It still remains unclear why compression of the left renal vein occurs in only a few patients despite its very peculiar course between the aorta and the SMA. Different anatomical details have been proposed. This controversy reflected itself on the lack of a clear agreement in regard to the treatment. We did a general overview of the current literature in an effort to elucidate further its pathophysiology. We present here three cases. The first case is that of a lady who presented with intermittent hematuria, sixteen years apart. Her hematuria cleared spontaneously without surgical intervention. Given her long symptom free interval, we strongly suspect some variable constitutional factors to play a role in the symptom development. The second case represents a perfectly healthy asymptomatic young women in whom an IVP done as routine renal donor work up revealed irregularities within the left collecting system that proved to be periureteric varices secondary to a nutcracker phenomenon as proved later by a renal angiogram. The third case describes a hypertensive, otherwise healthy, middle-aged male in whom an asymptomatic Nutcracker Phenomenon disclosed itself during a renal angiographic work up for his intractable hypertension. It is likely that the incidence of this anatomical problem is rather underestimated. We would like to emphasize the importance of its early inclusion in the differential diagnosis of left-sided hematuria because of the need for special testing for its diagnosis. Early proper diagnosis would spare many unneeded investigations.
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PMID:Nutcracker syndrome: an underdiagnosed cause for hematuria? 943 99

The nutcracker phenomenon refers to compression of the left renal vein between the aorta and the superior mesenteric artery. Clinical features are hematuria, abdominal pain, left flank pain, pelvic or scrotal discomfort due to varicocele or ovarian vein syndrome. In this report, 2 patients with orthostatic proteinuria, in whom nutcracker phenomenon was detected as a cause, are presented. One of them had posterior nutcracker with also asymptomatic varicocele that was detected during ultrasonographic examination. Nutcracker phenomenon is a rare but important clinical condition that should be considered in the differential diagnosis of patients with proteinuria and hematuria.
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PMID:The "nutcracker phenomenon" with orthostatic proteinuria: case reports. 1662 28

A 31-year-old man visited our hospital complaining of swelling in the left scrotum. Five days previously, he had felt sudden pain in the left lower abdomen and noticed swelling in the left scrotum. He had been suffering from intermittent gross hematuria and left flank pain for 1 year. An elastic hard mass was palpable in the left scrotum. Scrotal hematoma and marked dilation of left renal vein and left gonadal vein were revealed by computed tomography. A diagnosis of varicocele rupture secondary to nutcracker phenomenon was made. One month later, he underwent retroperitoneal laparoscopic donor nephrectomy and subsequent renal autotransplantation into the left iliac fossa. The post-operative course was uneventful. Gross hematuria was resolved 3 days after the operation, and swelling in the left scrotum was resolved within 6 months of the operation. Surgical intervention to treat nutcracker phenomenon is considered controversial. We believe that our procedure is a reliable option for surgical treatment for nutcracker phenomenon.
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PMID:[Renal autotransplantation for the treatment of nutcracker phenomenon which caused varicocele rupture : a case report]. 2164 54

Nutcracker syndrome results from left renal vein compression by the abdominal aorta and the superior mesenteric artery. The consecutively increased renal venous pressure results in hematuria, proteinuria, flank pain, left-sided varicocele, pelvic congestion, and others. We report a 25-year-old man with nutcracker syndrome who underwent successful left renocaval venous bypass with autologous great saphenous vein. The patient's condition clearly improved, with no clinical relapse after treatment. Ultrasound imaging showed patency of the venous bypass and decreased venous hypertension. This technique is a feasible choice for surgical treatment of nutcracker syndrome, with a low incidence of complications and satisfactory results.
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PMID:Left renocaval venous bypass with autologous great saphenous vein for nutcracker syndrome. 2205 77

Nutcracker syndrome (NCS), which is caused by compression of the left renal vein between the abdominal aorta and the superior mesenteric artery, leads to a series of clinical symptoms including hematuria, proteinuria, flank pain, and varicocele. The diagnosis of NCS is difficult due to variations in normal anatomy. Treatment, which ranges from observation to nephrectomy, remains controversial. We conducted a review based on the related literature and our experience with hundreds of cases. We summarize the characteristics of NCS, the different measurements used in diagnosis, and the current treatment options. We present our diagnostic criteria and recommend endovascular stenting as the primary option for NCS.
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PMID:Nutcracker syndrome--how well do we know it? 2413 44

The clinical manifestation of renal vein thrombosis varies with the speed and degree of venous occlusion. Such patients may be asymptomatic, have minor nonspecific symptoms such as nausea or weakness, or have more specific symptoms such as upper abdominal pain, flank pain, or hematuria. Acute scrotal pain is a very uncommon clinical expression of renal vein thrombosis. Here, we report a case of membranous glomerulonephritis-induced renal vein thrombosis presented with the symptom of acute scrotal pain caused by thrombosis-induced varicocele. This case report suggests that renal vein thrombosis should be considered in the diagnosis of acute scrotal pain; it also emphasizes that an investigation of retroperitoneum should be performed for adult patients with the sudden onset of varicocele.
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PMID:Acute scrotal pain: an uncommon manifestation of renal vein thrombosis. 2449 31


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